Exam 4 COTAC II Ameritech, Exam 4 Questions and Answers Graded A+
Ans: D
Feedback:
Decreased production of several clotting factors may be partially due to deficient absorption of vitamin
K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K to make
prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or albumin. - Answers 1. A
nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the
patient's increased risk of bleeding. The nurse recognizes that this risk is related to the patient's inability
to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?
A) Alterations in glucose metabolism
B) Retention of bile salts
C) Inadequate production of albumin by hepatocytes
D) Inability of the liver to use vitamin K
Ans: C
Feedback:
To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward
with light pressure with the other hand. The liver is not on the left side or in the right lower abdominal
quadrant. - Answers 2. A nurse is performing an admission assessment of a patient with a diagnosis of
cirrhosis. What technique should the nurse use to palpate the patient's liver?
A) Place hand under the right lower abdominal quadrant and press down lightly with the other hand.
B) Place the left hand over the abdomen and behind the left side at the 11th rib.
C) Place hand under right lower rib cage and press down lightly with the other hand.
D) Hold hand 90 degrees to right side of the abdomen and push down firmly.
Ans: C
Feedback:
Obstruction to blood flow through the damaged liver results in increased blood pressure (portal
hypertension) throughout the portal venous system. This can result in varices and ascites in the
abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal
hypertension is not synonymous with cardiovascular hypertension and does not create a risk for
unstable blood glucose or VTE. - Answers 3. A patient with portal hypertension has been admitted to the
,medical floor. The nurse should prioritize which of the following assessments related to the
manifestations of this health problem?
A) Assessment of blood pressure and assessment for headaches and visual changes
B) Assessments for signs and symptoms of venous thromboembolism
C) Daily weights and abdominal girth measurement
D) Blood glucose monitoring q4h
Ans: A, B
Feedback:
People who are at high risk, including nurses and other health care personnel exposed to blood or blood
products, should receive active immunization. The consistent use of standard precautions is also highly
beneficial. Vitamin supplementation is unrelated to an individual's risk of HBV. - Answers 4. A nurse
educator is teaching a group of recent nursing graduates about their occupational risks for contracting
hepatitis B. What preventative measures should the educator promote? Select all that apply.
A) Immunization
B) Use of standard precautions
C) Consumption of a vitamin-rich diet
D) Annual vitamin K injections
E) Annual vitamin B12 injections
Ans: A
Feedback:
Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment
finding, with no other action necessary. - Answers 5. A nurse is caring for a patient with cancer of the
liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse's
most recent assessment reveals the presence of dark green fluid in the collection container. What is the
nurse's best response to this assessment finding?
A) Document the presence of normal bile output.
B) Irrigate the drainage system with normal saline as ordered.
C) Aspirate a sample of the drainage for culture.
D) Promptly report this assessment finding to the primary care provider.
,Ans: C
Feedback:
The patient is given written and verbal instructions about immunosuppressive agent doses and dosing
schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of
medication is available so that there is no chance of running out of the medication or skipping a dose.
Failure to take medications as instructed may precipitate rejection. The nurse would not teach the
patient to measure drainage from a T-tube as the patient wouldn't go home with a T-tube. The nurse
may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the
nurse would not stress these topics over the immunosuppressive drug regimen. - Answers 6. A patient
who has undergone liver transplantation is ready to be discharged home. Which outcome of health
education should the nurse prioritize?
A) The patient will obtain measurement of drainage from the T-tube.
B) The patient will exercise three times a week.
C) The patient will take immunosuppressive agents as required.
D) The patient will monitor for signs of liver dysfunction.
Ans: A
Feedback:
Signs or symptoms of hepatic dysfunction indicate a need to assess for alcohol use. Immunization status,
occupational risks, and family history are also relevant considerations, but alcohol use is a more
common etiologic factor in liver disease. - Answers 7. A triage nurse in the emergency department is
assessing a patient who presented with complaints of general malaise. Assessment reveals the presence
of jaundice and increased abdominal girth. What assessment question best addresses the possible
etiology of this patient's presentation?
A) "How many alcoholic drinks do you typically consume in a week?"
B) "To the best of your knowledge, are your immunizations up to date?"
C) "Have you ever worked in an occupation where you might have been exposed to toxins?"
D) "Has anyone in your family ever experienced symptoms similar to yours?"
Ans: D
Feedback:
Octreotide (Sandostatin)—a synthetic analog of the hormone somatostatin—is effective in decreasing
bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin. Because of this
, safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate
control of variceal bleeding. Vitamin K and albumin are not administered and heparin would exacerbate,
not alleviate, bleeding. - Answers 8. A nurse is participating in the emergency care of a patient who has
just developed variceal bleeding. What intervention should the nurse anticipate?
A) Infusion of intravenous heparin
B) IV administration of albumin
C) STAT administration of vitamin K by the intramuscular route
D) IV administration of octreotide (Sandostatin)
Ans: A
Feedback:
The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating
asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple
figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath and not associated with a motor
disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a
reddening of the palms, but is not a flapping tremor. - Answers 9. A nurse is caring for a patient with
hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has
a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease?
A) Asterixis
B) Constructional apraxia
C) Fetor hepaticus
D) Palmar erythema
Ans: D
Feedback:
For people who have not been previously vaccinated, hepatitis A can be prevented by the intramuscular
administration of immune globulin during the incubation period, if given within 2 weeks of exposure.
Administration of the hepatitis A vaccine will not protect the patient exposed to hepatitis A, as
protection will take a few weeks to develop after the first dose of the vaccine. The hepatitis B vaccine
provides protection again the hepatitis B virus, but plays no role in protection for the patient exposed to
hepatitis A. Albumin confers no therapeutic benefit. - Answers 10. A local public health nurse is informed
that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise
individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?
A) The hepatitis A vaccine
Ans: D
Feedback:
Decreased production of several clotting factors may be partially due to deficient absorption of vitamin
K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K to make
prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or albumin. - Answers 1. A
nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the
patient's increased risk of bleeding. The nurse recognizes that this risk is related to the patient's inability
to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?
A) Alterations in glucose metabolism
B) Retention of bile salts
C) Inadequate production of albumin by hepatocytes
D) Inability of the liver to use vitamin K
Ans: C
Feedback:
To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward
with light pressure with the other hand. The liver is not on the left side or in the right lower abdominal
quadrant. - Answers 2. A nurse is performing an admission assessment of a patient with a diagnosis of
cirrhosis. What technique should the nurse use to palpate the patient's liver?
A) Place hand under the right lower abdominal quadrant and press down lightly with the other hand.
B) Place the left hand over the abdomen and behind the left side at the 11th rib.
C) Place hand under right lower rib cage and press down lightly with the other hand.
D) Hold hand 90 degrees to right side of the abdomen and push down firmly.
Ans: C
Feedback:
Obstruction to blood flow through the damaged liver results in increased blood pressure (portal
hypertension) throughout the portal venous system. This can result in varices and ascites in the
abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal
hypertension is not synonymous with cardiovascular hypertension and does not create a risk for
unstable blood glucose or VTE. - Answers 3. A patient with portal hypertension has been admitted to the
,medical floor. The nurse should prioritize which of the following assessments related to the
manifestations of this health problem?
A) Assessment of blood pressure and assessment for headaches and visual changes
B) Assessments for signs and symptoms of venous thromboembolism
C) Daily weights and abdominal girth measurement
D) Blood glucose monitoring q4h
Ans: A, B
Feedback:
People who are at high risk, including nurses and other health care personnel exposed to blood or blood
products, should receive active immunization. The consistent use of standard precautions is also highly
beneficial. Vitamin supplementation is unrelated to an individual's risk of HBV. - Answers 4. A nurse
educator is teaching a group of recent nursing graduates about their occupational risks for contracting
hepatitis B. What preventative measures should the educator promote? Select all that apply.
A) Immunization
B) Use of standard precautions
C) Consumption of a vitamin-rich diet
D) Annual vitamin K injections
E) Annual vitamin B12 injections
Ans: A
Feedback:
Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment
finding, with no other action necessary. - Answers 5. A nurse is caring for a patient with cancer of the
liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse's
most recent assessment reveals the presence of dark green fluid in the collection container. What is the
nurse's best response to this assessment finding?
A) Document the presence of normal bile output.
B) Irrigate the drainage system with normal saline as ordered.
C) Aspirate a sample of the drainage for culture.
D) Promptly report this assessment finding to the primary care provider.
,Ans: C
Feedback:
The patient is given written and verbal instructions about immunosuppressive agent doses and dosing
schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of
medication is available so that there is no chance of running out of the medication or skipping a dose.
Failure to take medications as instructed may precipitate rejection. The nurse would not teach the
patient to measure drainage from a T-tube as the patient wouldn't go home with a T-tube. The nurse
may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the
nurse would not stress these topics over the immunosuppressive drug regimen. - Answers 6. A patient
who has undergone liver transplantation is ready to be discharged home. Which outcome of health
education should the nurse prioritize?
A) The patient will obtain measurement of drainage from the T-tube.
B) The patient will exercise three times a week.
C) The patient will take immunosuppressive agents as required.
D) The patient will monitor for signs of liver dysfunction.
Ans: A
Feedback:
Signs or symptoms of hepatic dysfunction indicate a need to assess for alcohol use. Immunization status,
occupational risks, and family history are also relevant considerations, but alcohol use is a more
common etiologic factor in liver disease. - Answers 7. A triage nurse in the emergency department is
assessing a patient who presented with complaints of general malaise. Assessment reveals the presence
of jaundice and increased abdominal girth. What assessment question best addresses the possible
etiology of this patient's presentation?
A) "How many alcoholic drinks do you typically consume in a week?"
B) "To the best of your knowledge, are your immunizations up to date?"
C) "Have you ever worked in an occupation where you might have been exposed to toxins?"
D) "Has anyone in your family ever experienced symptoms similar to yours?"
Ans: D
Feedback:
Octreotide (Sandostatin)—a synthetic analog of the hormone somatostatin—is effective in decreasing
bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin. Because of this
, safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate
control of variceal bleeding. Vitamin K and albumin are not administered and heparin would exacerbate,
not alleviate, bleeding. - Answers 8. A nurse is participating in the emergency care of a patient who has
just developed variceal bleeding. What intervention should the nurse anticipate?
A) Infusion of intravenous heparin
B) IV administration of albumin
C) STAT administration of vitamin K by the intramuscular route
D) IV administration of octreotide (Sandostatin)
Ans: A
Feedback:
The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating
asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple
figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath and not associated with a motor
disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a
reddening of the palms, but is not a flapping tremor. - Answers 9. A nurse is caring for a patient with
hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has
a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease?
A) Asterixis
B) Constructional apraxia
C) Fetor hepaticus
D) Palmar erythema
Ans: D
Feedback:
For people who have not been previously vaccinated, hepatitis A can be prevented by the intramuscular
administration of immune globulin during the incubation period, if given within 2 weeks of exposure.
Administration of the hepatitis A vaccine will not protect the patient exposed to hepatitis A, as
protection will take a few weeks to develop after the first dose of the vaccine. The hepatitis B vaccine
provides protection again the hepatitis B virus, but plays no role in protection for the patient exposed to
hepatitis A. Albumin confers no therapeutic benefit. - Answers 10. A local public health nurse is informed
that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise
individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?
A) The hepatitis A vaccine
