Nursing 275 Exam 3 Test Questions
with All Correct Answers 2026
Updated.
Which statement by a client with cirrhosis indicates that further instruction is needed about the
disease?
A. "Cirrhosis is a chronic disease that has scarred my liver."
B. "The scars on my liver create problems with blood circulation."
C. "Because of the scars on my liver, blood clotting and blood pressure are affected."
D. "My liver is scarred, but the cells can regenerate themselves and repair the damage." -
Answer "My liver is scarred, but the cells can regenerate themselves and repair the damage."
Although cells and tissues will attempt to regenerate, this will result in permanent scarring and
irreparable damage. Cirrhosis is a chronic condition that leaves scars on the liver. Permanent
scars form in response to attempts by the cells to regenerate and create problems in blood
circulation moving through the liver. Liver scarring will create problems with blood clotting,
cholesterol levels, and blood pressure, as well as with the metabolism of drugs and toxins.
Which problem for a client with cirrhosis takes priority?
A. Insufficient knowledge related to the prognosis of the disease process
B. Discomfort related to the progression of the disease process
C. Potential for injury related to hemorrhage
D. Inadequate nutrition related to an inability to tolerate usual dietary intake - Answer
Potential for injury related to hemorrhage
Potential for injury related to hemorrhage is the priority client problem because this
complication could be life-threatening. Insufficient knowledge, discomfort, and inadequate
nutrition are not priorities because these issues are not immediately life-threatening.
How does the home care nurse best modify the client's home environment to manage side
effects of lactulose (Evalose)?
A. Provides small frequent meals for the client
B. Suggests taking daily potassium supplements
C. Elevates the head of the bed in high-Fowler's position
,D. Requests a bedside commode for the client - Answer Requests a bedside commode for the
client
Lactulose therapy increases the frequency of stools, so a bedside commode should be made
available to the client, especially if he or she has difficulty reaching the toilet. Small frequent
meals and elevating the head of the bed will not have any effect on the side effects of lactulose.
Although lactulose produces excessive stools and could potentially result in loss of potassium, it
is inappropriate for the nurse to suggest that the client take potassium supplements.
In caring for a client who has undergone paracentesis, which changes in the client's status
should be promptly reported to the provider?
A. Increased blood pressure, increased respiratory rate
B. Decreased blood pressure, increased heart rate
C. Increased respiratory rate, increased apical pulse, pallor
D. Tachypnea, diaphoresis, increased blood pressure - Answer Decreased blood pressure,
increased heart rate
Decreased blood pressure and increased heart rate are indicative of shock. Increased blood
pressure, increased respiratory rate, increased apical pulse, pallor, tachypnea, and diaphoresis
are all indicative of anxiety on the client's part.
The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose?
A. Provides enzymes necessary to digest dairy products
B. Reduces portal pressure
C. Promotes gastrointestinal (GI) excretion of ammonia
D. Decreases GI bleeding - Answer Promotes gastrointestinal (GI) excretion of ammonia
Lactulose reduces serum ammonia levels by excreting ammonia through the GI tract. Lactase is
the enzyme that digests dairy products. The mechanism of action of lactulose is not to reduce
portal pressure. Lactulose does not affect bleeding.
When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to
emphasize avoidance of which of these?
A. Vitamin K-containing products
B. Potassium-sparing diuretics
C. Nonabsorbable antibiotics
,D. Nonsteroidal anti-inflammatory drugs (NSAIDs) - Answer Nonsteroidal anti-inflammatory
drugs (NSAIDs)
Clients who have cirrhosis should not take NSAIDs because they may predispose to bleeding.
The client with cirrhosis is prone to bleeding; vitamin K can decrease bleeding, so it is not
necessary to restrict this in the diet. Potassium-sparing diuretics are used to reduce ascites.
Nonabsorbable antibiotics are used to decrease ammonia levels.
When caring for a client with hepatic encephalopathy, in which situation does the nurse
question the use of neomycin (Mycifradin)?
A. Kidney failure
B. Refractory ascites
C. Fetor hepaticus
D. Paracentesis scheduled for today - Answer Kidney failure
The aminoglycoside drugs, which include neomycin, are nephrotoxic and ototoxic, and should
not be taken by the client with hepatic encephalopathy. Cirrhosis and hepatic failure cause both
ascites and encephalopathy; no contraindication for neomycin is known. Fetor hepaticus causes
an ammonia smell to the breath when serum ammonia levels are elevated; neomycin is used to
decrease serum ammonia levels. The client may be NPO for a few hours before paracentesis,
but may take neomycin when the procedure is complete, or with less than 30 mL of water,
depending on hospital policy.
Which activity by the nurse will best relieve symptoms associated with ascites?
A. Administering oxygen
B. Elevating the head of the bed
C. Monitoring serum albumin levels
D. Administering intravenous fluids - Answer Elevating the head of the bed
The enlarged abdomen of ascites limits respiratory excursion; Fowler's position will increase
excursion and reduce shortness of breath. The client may need oxygen, but first the nurse
should raise the head of the bed to improve respiratory excursion and oxygenation. Monitoring
will detect anticipated decreased serum albumin levels associated with cirrhosis and hepatic
failure but does not relieve the symptoms of ascites. Administering IV fluids will contribute to
fluid volume excess and fluid shifts into the peritoneal cavity, worsening ascites.
The nurse is caring for clients in the outpatient clinic. Which of these phone calls should the
nurse return first?
, A. Client with hepatitis A reporting severe and ongoing itching
B. Client with severe ascites who has a temperature of 101.4° F (38° C)
C. Client with cirrhosis who has had a 3-pound weight gain over 2 days
D. Client with esophageal varices and mild right upper quadrant pain - Answer Client with
severe ascites who has a temperature of 101.4° F (38° C)
The client with ascites and an elevated temperature may have spontaneous bacterial peritonitis;
the nurse should call this client first. Itching is anticipated with jaundice, this client may be
called last. Weight gain with cirrhosis is not uncommon owing to low albumin levels. Cirrhosis
may cause mild right upper quadrant pain; this client should be called after the client with
severe ascites.
A client with a history of esophageal varices has just been admitted to the emergency
department after vomiting a large quantity of blood. Which action does the nurse take first?
A. Obtain the charts from the previous admission.
B. Listen for bowel sounds in all quadrants.
C. Obtain pulse and blood pressure.
D. Ask about abdominal pain. - Answer Obtain pulse and blood pressure.
The nurse should assess vital signs to detect hypovolemic shock caused by hemorrhage.
Obtaining charts, assessing bowel sounds, and pain assessment can be delayed until the client
has stabilized. Assessment for adequate perfusion is the highest priority at this time.
Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding
is most important to communicate to the heath care provider?
A. The dressing has a 2-cm area of serous drainage.
B. The client's platelet count is 135,000/mm3.
C. The client's albumin level is 2.8 mg/dL.
D. The client's heart rate is 122 beats/min. - Answer The client's heart rate is 122 beats/min.
Rapid removal of fluid may cause symptoms of shock; tachycardia, especially when associated
with hypotension, should be reported to the provider. A small amount of serous fluid may leak;
the dressing should be reinforced. Platelets will be checked before the procedure; these are
slightly low, but this is not a cause for concern. An albumin level of 2.8 mg/dL is an expected
finding for a client with cirrhosis; it is not life threatening.
Awarded 1.0 points out of 1.0 possible points.
with All Correct Answers 2026
Updated.
Which statement by a client with cirrhosis indicates that further instruction is needed about the
disease?
A. "Cirrhosis is a chronic disease that has scarred my liver."
B. "The scars on my liver create problems with blood circulation."
C. "Because of the scars on my liver, blood clotting and blood pressure are affected."
D. "My liver is scarred, but the cells can regenerate themselves and repair the damage." -
Answer "My liver is scarred, but the cells can regenerate themselves and repair the damage."
Although cells and tissues will attempt to regenerate, this will result in permanent scarring and
irreparable damage. Cirrhosis is a chronic condition that leaves scars on the liver. Permanent
scars form in response to attempts by the cells to regenerate and create problems in blood
circulation moving through the liver. Liver scarring will create problems with blood clotting,
cholesterol levels, and blood pressure, as well as with the metabolism of drugs and toxins.
Which problem for a client with cirrhosis takes priority?
A. Insufficient knowledge related to the prognosis of the disease process
B. Discomfort related to the progression of the disease process
C. Potential for injury related to hemorrhage
D. Inadequate nutrition related to an inability to tolerate usual dietary intake - Answer
Potential for injury related to hemorrhage
Potential for injury related to hemorrhage is the priority client problem because this
complication could be life-threatening. Insufficient knowledge, discomfort, and inadequate
nutrition are not priorities because these issues are not immediately life-threatening.
How does the home care nurse best modify the client's home environment to manage side
effects of lactulose (Evalose)?
A. Provides small frequent meals for the client
B. Suggests taking daily potassium supplements
C. Elevates the head of the bed in high-Fowler's position
,D. Requests a bedside commode for the client - Answer Requests a bedside commode for the
client
Lactulose therapy increases the frequency of stools, so a bedside commode should be made
available to the client, especially if he or she has difficulty reaching the toilet. Small frequent
meals and elevating the head of the bed will not have any effect on the side effects of lactulose.
Although lactulose produces excessive stools and could potentially result in loss of potassium, it
is inappropriate for the nurse to suggest that the client take potassium supplements.
In caring for a client who has undergone paracentesis, which changes in the client's status
should be promptly reported to the provider?
A. Increased blood pressure, increased respiratory rate
B. Decreased blood pressure, increased heart rate
C. Increased respiratory rate, increased apical pulse, pallor
D. Tachypnea, diaphoresis, increased blood pressure - Answer Decreased blood pressure,
increased heart rate
Decreased blood pressure and increased heart rate are indicative of shock. Increased blood
pressure, increased respiratory rate, increased apical pulse, pallor, tachypnea, and diaphoresis
are all indicative of anxiety on the client's part.
The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose?
A. Provides enzymes necessary to digest dairy products
B. Reduces portal pressure
C. Promotes gastrointestinal (GI) excretion of ammonia
D. Decreases GI bleeding - Answer Promotes gastrointestinal (GI) excretion of ammonia
Lactulose reduces serum ammonia levels by excreting ammonia through the GI tract. Lactase is
the enzyme that digests dairy products. The mechanism of action of lactulose is not to reduce
portal pressure. Lactulose does not affect bleeding.
When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to
emphasize avoidance of which of these?
A. Vitamin K-containing products
B. Potassium-sparing diuretics
C. Nonabsorbable antibiotics
,D. Nonsteroidal anti-inflammatory drugs (NSAIDs) - Answer Nonsteroidal anti-inflammatory
drugs (NSAIDs)
Clients who have cirrhosis should not take NSAIDs because they may predispose to bleeding.
The client with cirrhosis is prone to bleeding; vitamin K can decrease bleeding, so it is not
necessary to restrict this in the diet. Potassium-sparing diuretics are used to reduce ascites.
Nonabsorbable antibiotics are used to decrease ammonia levels.
When caring for a client with hepatic encephalopathy, in which situation does the nurse
question the use of neomycin (Mycifradin)?
A. Kidney failure
B. Refractory ascites
C. Fetor hepaticus
D. Paracentesis scheduled for today - Answer Kidney failure
The aminoglycoside drugs, which include neomycin, are nephrotoxic and ototoxic, and should
not be taken by the client with hepatic encephalopathy. Cirrhosis and hepatic failure cause both
ascites and encephalopathy; no contraindication for neomycin is known. Fetor hepaticus causes
an ammonia smell to the breath when serum ammonia levels are elevated; neomycin is used to
decrease serum ammonia levels. The client may be NPO for a few hours before paracentesis,
but may take neomycin when the procedure is complete, or with less than 30 mL of water,
depending on hospital policy.
Which activity by the nurse will best relieve symptoms associated with ascites?
A. Administering oxygen
B. Elevating the head of the bed
C. Monitoring serum albumin levels
D. Administering intravenous fluids - Answer Elevating the head of the bed
The enlarged abdomen of ascites limits respiratory excursion; Fowler's position will increase
excursion and reduce shortness of breath. The client may need oxygen, but first the nurse
should raise the head of the bed to improve respiratory excursion and oxygenation. Monitoring
will detect anticipated decreased serum albumin levels associated with cirrhosis and hepatic
failure but does not relieve the symptoms of ascites. Administering IV fluids will contribute to
fluid volume excess and fluid shifts into the peritoneal cavity, worsening ascites.
The nurse is caring for clients in the outpatient clinic. Which of these phone calls should the
nurse return first?
, A. Client with hepatitis A reporting severe and ongoing itching
B. Client with severe ascites who has a temperature of 101.4° F (38° C)
C. Client with cirrhosis who has had a 3-pound weight gain over 2 days
D. Client with esophageal varices and mild right upper quadrant pain - Answer Client with
severe ascites who has a temperature of 101.4° F (38° C)
The client with ascites and an elevated temperature may have spontaneous bacterial peritonitis;
the nurse should call this client first. Itching is anticipated with jaundice, this client may be
called last. Weight gain with cirrhosis is not uncommon owing to low albumin levels. Cirrhosis
may cause mild right upper quadrant pain; this client should be called after the client with
severe ascites.
A client with a history of esophageal varices has just been admitted to the emergency
department after vomiting a large quantity of blood. Which action does the nurse take first?
A. Obtain the charts from the previous admission.
B. Listen for bowel sounds in all quadrants.
C. Obtain pulse and blood pressure.
D. Ask about abdominal pain. - Answer Obtain pulse and blood pressure.
The nurse should assess vital signs to detect hypovolemic shock caused by hemorrhage.
Obtaining charts, assessing bowel sounds, and pain assessment can be delayed until the client
has stabilized. Assessment for adequate perfusion is the highest priority at this time.
Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding
is most important to communicate to the heath care provider?
A. The dressing has a 2-cm area of serous drainage.
B. The client's platelet count is 135,000/mm3.
C. The client's albumin level is 2.8 mg/dL.
D. The client's heart rate is 122 beats/min. - Answer The client's heart rate is 122 beats/min.
Rapid removal of fluid may cause symptoms of shock; tachycardia, especially when associated
with hypotension, should be reported to the provider. A small amount of serous fluid may leak;
the dressing should be reinforced. Platelets will be checked before the procedure; these are
slightly low, but this is not a cause for concern. An albumin level of 2.8 mg/dL is an expected
finding for a client with cirrhosis; it is not life threatening.
Awarded 1.0 points out of 1.0 possible points.
