Care of Clients with Hepato-Biliary and Pancreatic Disorder

1. If a gallstone becomes lodges in the common bile duct, the nurse should anticipate that the client’s stools
would most likely become what color?
a. Green
b. Gray
c. Black
d. Brown

2. When the client’s common bile duct is obstructed, the nurse should evaluate the client for signs of which
of the following complications?
a. Respiratory distress
b. Circulatory overload
c. Urinary tract infection
d. Prolonged bleeding time

3. A client undergoes a traditional cholecystectomy and choledochotomy and returns from surgery with a
T-tube. To evaluate the effectiveness of the T-tube, the nurse should understand that the primary reason
for the T-tube is to accomplish which of the following goals?
a. Promote wound drainage
b. Provide a way to irrigate the tract
c. Minimize the passage of bile into the duodenum
d. Prevent the bile into the duodenum

4. After a cholecystectomy it is recommended that the client follows a low-fat diet at home. Which of the
following foods would be most appropriate to include in a low-fat diet?
a. Cheese omelet
b. Peanut butter
c. Ham salad sandwich
d. Roasted beef

5. A client undergoes a laparoscopic cholecystectomy. Which of the following dietary instructions would
the nurse give the client immediately after surgery?
a. “You cannot eat or drink anything for 24 hours.”
b. “You may resume your normal diet the day after surgery.”
c. Drink liquid today and eat lightly for a few days.”
d. “You can progress from a liquid to a bland diet as tolerated.”

6. When providing for a client with acute pancreatitis, the nurse would anticipate which of the following
orders?
a. Increase oral intake 3000 mls every 24 hours.
b. Insert a nasogastric tube and connect it to low suction
c. Place the client in the reverse Trendelenburg position
d. Place the client on precautions
7. The nurse notes that a client with acute pancreatitis occasionally experiences muscle twitching and
jerking. How should the nurse interpret the significance of these symptoms?
a. The client maybe developing hypocalcemia
 b. The client is experiencing a reaction to Meperidine (Demerol)
c. The client has a nutritional imbalance
d. The client needs a muscle relaxant to help him rest

8. Pancreatic enzyme replacements are ordered for the client with chronic pancreatitis. When should the
nurse instruct the client to take them to obtain the most therapeutic effect?
a. Three times daily between meals
b. With each meal and snack
c. In the morning and at bedtime
d. Every 4 hours, at specified times.

9. The nurse should teach a client with chronic pancreatitis to monitor the effectiveness of pancreatic
enzyme replacement therapy by doing which of the following?
a. Monitor fluid intake
b. Performing regular glucose fingerstick test
c. Observing stools for steatorrhea
d. Testing urine for ketones

10. The nurse is assessing a client who is in the early stage of cirrhosis of the liver. Which of the following
signs would the nurse anticipate finding?
a. Peripheral edema
b. Ascites
c. Anorexia
d. Jaundice

11. Which diet should be implemented to a client who is in the early stages of cirrhosis?
a. High calorie, high carbohydrates
b. High protein, low fat
c. Low fat, low protein
d. High carbohydrates, low sodium

12. The client has developed ascites. The nurse should recognize that the pathologic basis for the
development of ascites in clients with cirrhosis is portal hypertension and:
a. An excess serum and sodium level
b. An increased metabolism of aldosterone
c. A decreased flow of hepatic lymph
d. A decreased serum albumin

13. A client with cirrhosis vomits bright red blood and the physician decides to insert a Sengstaken-
Blakemore tube. The nurse should explain to the client that the tube acts by:
a. Providing a large diameter for effective gastric lavage
b. Applying direct pressure to gastric bleeding sites
c. Blocking blood flow to gastric bleeding sites
d. Apply direct pressure to esophagus

14. The physician orders oral neomycin and neomycin enema for the client with cirrhosis. The nurse
understands that the purpose of this therapy is to:
 a. Reduce abdominal pressure
b. Prevent straining during defecation
c. Block ammonia formation
d. Reduce bleeding within the intestine

15. A client’s serum ammonia level is elevated and the physician orders 30ml of lactulose (Cephulac).
Which of the following side effects of this drug would the nurse expect to see?
a. Increased urine output
b. Improved level of consciousness
c. Increased bowel movements
d. Nausea and vomiting

16. The nurse is providing discharge instructions for the client with cirrhosis. Which of the following
statements best indicates that the client has understood the teaching?
a. “I should eat a high-protein, high-carbohydrate diet to provide energy.”
b. “It is safer for me to take acetaminophen (Tylenol) for pain instead of aspirin.”
c. “I should avoid constipation to decrease chances of bleeding.”
d. “If I get enough rest and follow my diet it is possible for my cirrhosis to be cured.”

17. A client is taking an antacid for treatment of peptic ulcer disease. Which of the following statements best
indicates that the client understands how to correctly take the antacid?
a. “I should take the antacid before I take my other medicine.”
b. “I need to decrease my intake of fluids so that I don’t dilute the effect of my medicine.”
c. “My antacid will be most effective if I take it whenever I experience stomach pain.”
d. “It is best for me to take my antacid 1 to 2 hours after meals.”

18. The client tells the nurse that since his diagnosis of stomach cancer, he has been having trouble sleeping
and frequently preoccupied with thought about how his life will change. He says, “I wish my life could
stay the same.” Based on this information, which of the following nursing diagnoses would be
appropriate at this time?
a. Ineffective coping related to the diagnosis of cancer
b. Disturbed sleep pattern related to the fear of unknown
c. Anticipatory grieving related to the diagnosis of cancer
d. Anxiety related to need of gastric surgery
19. As a result of gastric resection, the client is at risk for development of dumping syndrome. The nurse
would prepare a plan of care for this client based on knowledge that this problem stems primarily from
which of the following gastrointestinal changes?
a. Excess secretion of digestive enzymes in the intestines
b. Rapid emptying of stomach content into the small intestine
c. Excess glycogen production by the liver
d. Loss of gastric enzymes

20. The nurse evaluates the client’s stoma during initial postoperative period. Which of the following
observations should be reported immediately to the physician?
a. The stoma is slightly edematous
b. The stoma is dark red to purple
c. The stoma oozes a small amount of blood
d. The stoma does not expel stool
21. While changing the client’s colostomy bag and dressing, the nurse assesses that the client is ready to
participate in her care by noting which of the following?
a. The client asks what time the doctor will visit that day
b. The client asks on the supplies used during the dressing change
c. The client talks about something she read in the morning newspaper
d. The client complains about the way the night nurse changed the dressing

22. Which goal for the client’s care should take priority during the first day of hospitalization for an
exacerbation of ulcerative colitis?
a. Promoting self-care and independence
b. Managing diarrhea
c. Maintaining adequate nutrition
d. Promoting rest and comfort

23. After the insertion of nasogastric tube-like Miller-Abbot tube, the nurse should place the client in which
position?
a. Supine
b. Right-side lying
c. Semi-fowlers
d. Upright in a bedside chair

24. Which of the following should the nurse interpret as an indication of a complication after the first few
days of TPN therapy?
a. Glycosuria/glucosuria
b. A 1-2 lb. weight gain
c. Decreased appetite
d. Elevated temperature

25. In a client with acute appendicitis the nurse should anticipate which of the following treatments?
a. Administration of enemas to cleanse the bowel
b. Insertion of a nasogastric tube
c. Placement of client on NPO status
d. Administration of heat to the abdomen

26. If a gallstone becomes lodged in the common bile duct, the nurse should anticipate that the client’s
stools would most likely become what color?
a. Green
b. Gray
c. Black
d. Brown

27. The nurse instructed client with viral hepatitis about the type of diet that should be eaten. The lunch
selection that would indicate the client’s understanding and compliance with the dietary principles
taught is:
a. Turkey salad, French fries, sherbet
b. Cheeseburger, taco, chips, chocolate pudding
 c. Salad, sliced chicken sandwich, gelatin dessert
d. Cottage cheese, peanut butter sandwich, milkshake

28. The nurse is reviewing discharge plans with a client who has been hospitalized with hepatitis A. the
nurse would recognize that the client understood preventive measures that should be used to reduce risk
of spreading the disease when the client states, “I should:
a. Wash my hand frequently
b. Dispose of my tissue properly
c. Launder my clothes separately
d. Use sterile dressing and equipment

29. A mother brings her week-old infant to the clinic because the infant continually regurgitates. Chalasia is
suspected. The nurse instructs the mother to:
a. Keep the infant prone following feedings
b. Prevent the infant from crying for prolonged periods
c. Administer a minimum of 8 oz. of formula at each feeding
d. Keep the infant in a semi-sitting position, particularly after feedings.

30. A mother asks the nurse how she should introduce pureed foods to her 9-month-old infant. The nurse’s
best response would be:
a. “Mix the pureed food with formula twice a day.”
b. “Introduce one food at a time, usually at intervals of 4-7 days.”
c. “Give the pureed food by spoon after the infant has had formula.”
d. “Keep the formula intake fairly constant regardless of the solid food intake.”

31. The sequence for introducing other food into a baby’s diet after introduction of cereal is:
a. Meats, fruits, vegetables, table foods
b. Vegetables, table foods, meats, fruits
c. Table foods, fruits, vegetables, meats
d. Fruits, vegetables, meats, table foods

32. A nurse can assist a suspected diagnosis of intestinal pinworms in a 6-year-old child by:
a. Asking the mother to collect stools for 3 consecutive days for culture
b. Instructing the mother to do an anal Scotch-tape test early in the morning
c. Having the mother bring the child’s stools for visual examination for 3 days
d. Assisting the mother to schedule a hypersensitivity test of the child’s blood serum

33. An infant is diagnosed as having pyloric stenosis. When palpating this infant’s abdomen, the nurse
would expect to find:
a. An impacted and distended colon
b. Marked tenderness around the umbilicus
c. An olive-sized mass in the right upper abdomen
d. Rhythmic peristaltic waves in the lower abdomen

34. One symptom common in children with celiac disease is stool that are:
a. Small, pale, mucoid
b. Large, frothy, dark green
 c. Large, pale, foul smelling
d. Moderate, green, foul-smelling

35. A test that is done on all neonates to detect PKU is:

a. Dextrostix test
b. Guthrie blood test
c. Phenistix test
d. Coomb’s test

36. The behavior of an infant with colic is usually suggestive of:

a. An allergic response to certain protein in milk
b. Inadequate peristalsis resulting in constipation
c. Paroxysmal abdominal pain by excessive gas
d. A protective mechanism designed to rid the GI tract of foreign protein

37. Twenty-four hours after birth the newborn has not passed meconium ad Hirschsprung’s disease is
suspected. To help relive the obstruction and confirm the diagnosis the physician will probably order:
a. Multiple saline enemas
b. Surgical intervention
c. Insertion of rectal tube PRN
d. Placement of a nasogastric tube

38. The mother of a 20-month old female has question about her daughter’s bowel training. The nurse
advises the mother that training will be more successful if she:
a. Starts while her daughter is still on formula
b. Sits her daughter in the toile every two hours
c. Begins by placing her daughter on a potty chair
d. Begins the bowel training when her daughter is 2 months old

39. Children with cystic fibrosis are usually small and underdeveloped for their age primarily because they:
a. Ingest little food because of an extremely poor appetite
b. Secrete less than normal amount of pituitary growth hormone
c. Develop muscular and bony atrophy from lack of motor activity
d. Are unable to absorb nutrients because of a lack of pancreatic enzymes

40. Mebendazole (Vermox) 100 mg BID x 3 days is ordered for a child with pinworms. It is advisable that
this drug also be administered to:
a. The child’s younger brother who is 1 year old
b. All members of the child’s family who test positive
c. All people using the same toilet facilities as the child
d. The child’s mother, father and siblings even though they are symptoms-free

41. For a client in hepatic coma, which outcome would be the most appropriate?
a. The client is oriented to time, place, and person
b. The client exhibits no ecchymotic areas.
c. The client increases oral intake to 2,000 calories/day
d. The client exhibits increased serum albumin level.
42. Jordin is a client with jaundice who is experiencing pruritus. Which nursing intervention would be
included in the care plan for the client?
a. Administering vitamin K subcutaneously
b. Applying pressure when giving I.M. injections
c. Decreasing the client’s dietary protein intake
d. Keeping the client’s fingernails short and smooth

43. Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet, when selected by the client,
indicates that the nurse‘s teaching has been successful?
a. 4-6 small meals of low-carbohydrate foods daily
b. High-fat, high-carbohydrate meals
c. Low-fat, high-carbohydrate meals
d. High-fat, low protein meals

44. The hospital administrator had undergone percutaneous transhepatic cholangiography. which assessment
finding indicates complication after the operation?
a. Fever and chills
b. Hypertension
c. Bradycardia
d. Nausea and diarrhea

45. When planning home care for a client with hepatitis A, which preventive measure should be
emphasized to protect the client’s family?
a. Keeping the client in complete isolation
b. Using good sanitation with dishes and shared bathrooms
c. Avoiding contact with blood-soiled clothing or dressing
d. Forbidding the sharing of needles or syringes

46. For Jayvin who is taking antacids, which instruction would be included in the teaching plan?
a. “Take the antacids with 8 oz of water.”
b. “Avoid taking other medications within 2 hours of this one.”
c. “Continue taking antacids even when pain subsides.”
d. “Weigh yourself daily when taking this medication.”

47. Which clinical manifestation would the nurse expect a client diagnosed with acute cholecystitis to
exhibit?
a. Jaundice, dark urine, and steatorrhea
b. Acute right lower quadrant (RLQ) pain, diarrhea, and dehydration
c. Ecchymosis petechiae, and coffee-ground emesis
d. Nausea, vomiting, and anorexia

48. Pierre who is diagnosed with acute pancreatitis is under the care of Nurse Bryan. Which intervention
should the nurse include in the care plan for the client?
a. Administration of vasopressin and insertion of a balloon tamponade
b. Preparation for a paracentesis and administration of diuretics
c. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low
intermittent suction
d. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day

49. When teaching a client about pancreatic function, the nurse understands that pancreatic lipase performs
which function?
a. Transports fatty acids into the brush border
 b. Breaks down fat into fatty acids and glycerol
c. Triggers cholecystokinin to contract the gallbladder
d. Breaks down protein into dipeptides and amino acids

50. A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed with
ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering diuretic
therapy, which nursing action would be most effective in ensuring safe care?
a. Measuring serum potassium for hyperkalemia
b. Assessing the client for hypervolemia
c. Measuring the client’s weight weekly
d. Documenting precise intake and output

51. Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in the
client with hepatic encephalopathy?
a. Passage of two or three soft stools daily
b. Evidence of watery diarrhea
c. Daily deterioration in the client’s handwriting
d. Appearance of frothy, foul-smelling stools

52. Nurse Farrah is providing care for Kristoff who has jaundice. Which statement indicates that the nurse
understands the rationale for instituting skin care measures for the client?
a. “Jaundice is associated with pressure ulcer formation.”
b. “Jaundice impairs urea production, which produces pruritus.”
c. “Jaundice produces pruritus due to impaired bile acid excretion.”
d. “Jaundice leads to decreased tissue perfusion and subsequent breakdown.”

53. Which rationale supports explaining the placement of an esophageal tamponade tube in a client who is
hemorrhaging?
a. Allowing the client to help insert the tube
b. Beginning teaching for home care
c. Maintaining the client’s level of anxiety and alertness
d. Obtaining cooperation and reducing fear

54. For Rico who has chronic pancreatitis, which nursing intervention would be most helpful?
a. Allowing liberalized fluid intake
b. Counseling to stop alcohol consumption
c. Encouraging daily exercise
d. Modifying dietary protein

55. Mr. Hasakusa is in end-stage liver failure. Which interventions should the nurse implement when
addressing hepatic encephalopathy? (Select all that apply.)
a. Assessing the client’s neurologic status every 2 hours
b. Monitoring the client’s hemoglobin and hematocrit levels
c. Evaluating the client’s serum ammonia level
d. Monitoring the client’s handwriting daily
e. Preparing to insert an esophageal tamponade tube
f. Making sure the client’s fingernails are short

56. For a client with hepatic cirrhosis who has altered clotting mechanisms, which intervention would be
most important?
a. Allowing complete independence of mobility
b. Applying pressure to injection sites
 c. Administering antibiotics as prescribed
d. Increasing nutritional intake

57. A client with advanced cirrhosis has been diagnosed with hepatic encephalopathy. The nurse expects to
assess for:
a. Malaise
b. Stomatitis
c. Hand tremors
d. Weight loss

58. A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic
encephalopathy. Which of the following nursing interventions are appropriate to prevent skin
breakdown? (Select all that apply.)
a. Range of motion every 4 hours
b. Turn and reposition every 2 hours
c. Abdominal and foot massages every 2 hours
d. Alternating air pressure mattress
e. Sit in chair for 30 minutes each shift

59. Which of the following will the nurse include in the care plan for a client hospitalized with viral
hepatitis?
a. Increase fluid intake to 3000 ml per day
b. Adequate bed rest
c. Bland diet
d. Administer antibiotics as ordered

60. Spironolactone (Aldactone) is prescribed for a client with chronic cirrhosis and ascites. The nurse should
monitor the client for which of the following medication-related side effects?
a. Jaundice
b. Hyperkalemia
c. Tachycardia
d. Constipation

61. Inside the pancreas are special cells that secrete digestive enzymes and hormones. The cells that secrete
digestive enzymes are known as ______________ cells.
a. Islet of Langerhans
b. Protease
c. Acinar
d. Amylase

62. From the pancreas and gallbladder, the common bile duct and pancreatic duct open into the
____________ where digestive enzymes and bile flow through the duodenum via the major duodenal
papilla which is surrounded by a muscular valve that controls the release of digestive enzymes known as
the ______________.
a. ampulla of vater, sphincter of Oddi
b. papilla of vater, sphincter of Oddi
c. minor duodenal papilla, ampulla of vater
d. jejunum, sphincter of pylori

63. Select-ALL-that-apply: In the pancreas, the acinar cells release:

a. Amylase
b. Somatostatin
 c. Lipase
d. Protease

64. You’re caring for a 45-year-old patient who is admitted with suspected acute pancreatitis. The patient
reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started
last night after eating fast food. As the nurse, you know the two most common causes of acute
pancreatitis are:
a. High cholesterol and alcohol abuse
b. History of diabetes and smoking
c. Pancreatic cancer and obesity
d. Gallstones and alcohol abuse

65. Which patient below is at MOST risk for CHRONIC pancreatitis?

a. A 25 year old female with a family history of gallstones.
b. A 35 year old male who reports social drinking of alcohol.
c. A 15 year old female with cystic fibrosis.
d. A 66 year old female with stomach cancer.

66. Your patient with acute pancreatitis is scheduled for a test that will use a scope to assess the pancreas,
bile ducts, and gallbladder. The patient asks you, “What is the name of the test I’m going for later
today?” You tell the patient it is called:
a. MRCP
b. ERCP
c. CT scan of the abdomen
d. EGD

67. A patient is admitted to the ER with the following signs and symptoms: very painful mid-epigastric pain
felt in the back, elevated glucose, fever, and vomiting. During the head-to-toe assessment, you notice
bluish discoloration around the belly button. As the nurse, you know this is called?
a. Grey-Turner’s Sign
b. McBurney’s Sign
c. Homan’s Sign
d. Cullen’s Sign

68. While assisting a patient with chronic pancreatitis to the bathroom, you note the patient’s stool to be
oily/greasy in appearance. In your documentation you note this as:
a. Steatorrhea
b. Melena
c. Currant
d. Hematochezia

69. A patient with acute pancreatitis is reporting excessive thirst, excessive voiding, and blurred vision. As
the nurse, it is priority you?
a. Reassure the patient this is normal with pancreatitis
b. Check the patient’s blood glucose
c. Assist the patient with drinking a simple sugar drink like orange juice
d. Provide a dark and calm environment

70. A patient who received treatment for pancreatitis is being discharged home. You’re providing diet
teaching to the patient. Which statement by the patient requires immediate re-education about the diet
restrictions?
a. “It will be hard but I will eat a diet low in fat and avoid greasy foods.”
 b. “It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week.”
c. “I will concentrate on eating complex carbohydrates rather than refined carbohydrates.”
d. “I will purchase foods that are high in protein.”

71. The physician orders a patient with pancreatitis to take a pancreatic enzyme. What assessment finding
demonstrates the pancreatic enzymes are working properly?
a. Abdominal girth is decreased
b. Skin turgor is less than 2 seconds
c. Blood glucose is 250
d. Stools appear formed and solid

72. During a home health visit, you are assessing how a patient takes the prescribed pancreatic enzyme. The
patient is unable to swallow the capsule whole, so they open the capsule and mix the beads inside the
capsule with food/drink. Which food or drink is safe for the patient to mix the beads with?
a. Pudding
b. Ice cream
c. Milk
d. Applesauce

73. The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will
monitor for effectiveness of this medication for this patient by assessing what?
a. Relief of constipation
b. Relief of abdominal pain
c. Decreased liver enzymes
d. Decreased ammonia levels

74. The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent
becoming ill themselves. Which response by the nurse is most appropriate?
a. "The hepatitis vaccine will provide immunity from this exposure and future exposures."
b. "I am afraid there is nothing you can do since the patient was infectious before admission."
c. "You will need to be tested first to make sure you don't have the virus before we can treat you."
d. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from
this exposure."

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

76. When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting
from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to
achieve this outcome (select all that apply)?
a. Use smallest gauge needle possible when giving injections or drawing blood.
b. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing.
c. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food.
d. Apply gentle pressure for the shortest possible time period after performing venipuncture.
e. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.
77. A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has
a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse
attribute these findings?
a. Malnutrition
b. Osteomyelitis
c. Alcohol abuse
d. Diabetic Mellitus

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

79. A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain
medication after knee surgery. Which medication order should the nurse question because it is most
likely to cause hepatic complications?
a. Tramadol
b. Hydromorphone
c. Oxycodone with aspirin
d. Hydrocodone with acetaminophen

80. The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals
cholelithiasis. What should the nurse expect to do for this patient?
a. Prevent all oral intake.
b. Control abdominal pain.
c. Provide enteral feedings.
d. Avoid dietary cholesterol.

81. A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a
contraindication for a cholecystectomy?
a. Low-grade fever of 100° F and dehydration
b. Abscess in the right upper quadrant of the abdomen
c. Activated partial thromboplastin time (aPTT) of 54 seconds
d. Multiple obstructions in the cystic and common bile duct

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

83. The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more
teaching?
a. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis."
b. "I need to take good care of my belly and ankle skin where it is swollen."
c. "A scrotal support may be more comfortable when I have scrotal edema."
d. "I can use pillows to support my head to help me breathe when I am in bed."
84. The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering
liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered
may be a contraindication for liver transplantation?
a. Has completed a college education
b. Has been able to stop smoking cigarettes
c. Has well-controlled type 1 diabetes mellitus
d. The chest x-ray showed another lung cancer lesion.

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

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

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

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

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

90. The nurse is caring for a group of patients. Which patient is at highest risk for pancreatic cancer?
a. A 38-year-old Hispanic female who is obese and has hyperinsulinemia
b. A 23-year-old who has cystic fibrosis-related pancreatic enzyme insufficiency
c. A 72-year-old African American male who has smoked cigarettes for 50 years
d. A 19-year-old who has a 5-year history of uncontrolled type 1 diabetes mellitus
91.  A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the
following findings is the priority to be reported to the provider?
a. History of cholelithiasis
b. Serum amylase levels three times greater than the expected value
c. Client report of severe pain radiating to the back that is rated at an "8"
d. Hand spasms present when blood pressure is checked

92.  A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following
is an expected finding?
a. Pain in right upper quadrant radiating to right shoulder
b. Report of pain being worse when sitting upright
c. Pain relieved with defecation
d. Epigastric pain radiating to left shoulder

93. A nurse is reviewing the health record of a client who has pancreatitis. The physical exam report by the
provider indicates the presence of Cullen's sign. Which of the following is an appropriate action by the
nurse to identify this finding?
a. Tap lightly at the costovertebral margin on the client's back.
b. Palpate the client's right lower quadrant.
c. Inspect the skin around the umbilicus.
d. Auscultate the area below the client's scapula.

94.  A nurse is completing preoperative teaching for a client who will undergo a laparoscopic
cholecystectomy. Which of the following should be included in the teaching?
a. "The scope will be passed through your rectum."
b. "You may have shoulder pain after surgery."
c. "The T-tube will remain in place for 1 to 2 weeks."
d. "You should limit how often you walk for 1 to 2 weeks."

95.  A nurse is reviewing a new prescription for ursodiol (Ursodeoxycholic Acid) with a client who has
cholelithiasis. Which of the following should be included in the teaching?
a. This medication reduces biliary spasms.
b. This medication reduces inflammation in the biliary tract.
c. This medication dilates the bile duct to promote passage of bile.
d. This medication dissolves gall stones.

96. A nurse is teaching a client who has hepatitis B about home care. Which of the following should the
nurse include in the teaching? (Select all that apply.)
a. Limit physical activity.
b. Avoid alcohol.
c. Take acetaminophen for comfort.
d. Wear a mask when in public places.
e. Eat small frequent meals.

97. When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting
from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to
achieve this outcome (select all that apply)?
a. Use smallest gauge needle possible when giving injections or drawing blood.
b. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing.
c. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food
d. Apply gentle pressure for the shortest possible time period after performing venipuncture
e. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.
98. The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that
this fluid gathers in the abdomen for which reasons (select all that apply)?
a. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin.
b. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention.
c. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal
cavity.
d. Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in
fluids orally.
e. Overactivity of the enlarged spleen results in increased removal of blood cells from the
circulation, which decreases the vascular pressure.

99. The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder
disease. Which statement by the patient to the nurse indicates she understands the instructions?
a. "This medication will help me digest fats and fat-soluble vitamins."
b. "I will apply the medicated lotion sparingly to the areas where I itch."
c. "The medication is a powder and needs to be mixed with milk or juice."
d. "I should take this medication on an empty stomach at the same time each day."

100. A nurse is reviewing nutrition teaching for a client who has cholecystitis. Which of the following
food choices can trigger cholecystitis?
a. Brownie with nuts
b. Bowl of mixed fruit
c. Grilled turkey
d. Baked potato