N4301 ADULTS 2: FINAL EXAM
QUESTIONS AND CORRECT
ANSWERS
When cplanning ccare cfor ca cpatient cwith ccirrhosis, cthe cnurse cwill cgive chighest cpriority
cto cwhich cof cthe cfollowing cnursing cdiagnoses?
A. cImbalanced cnutrition: cless cthan cbody crequirements
B. cImpaired cskin cintegrity crelated cto cedema, cascites, cand cpruritus
C. cExcess cfluid cvolume crelated cto cportal chypertension cand chyperaldosteronism c
D. cIneffective cbreathing cpattern crelated cto cpressure con cdiaphragm cand creduced
clung cvolume c- ccorrect cansD. cIneffective cbreathing cpattern crelated cto cpressure con
cdiaphragm cand creduced clung cvolume c
ABC
A c54-year-old cpatient cadmitted cwith cdiabetes cmellitus, cmalnutrition, costeomyelitis,
cand calcohol cabuse chas ca cserum camylase clevel cof c280 cU/L cand ca cserum clipase
clevel cof c310 cU/L. cTo cwhich cof cthe cfollowing cdiagnoses cdoes cthe cnurse cattribute
cthese cfindings?
A. cMalnutrition
B. cOsteomyelitis
C. cAlcohol cabuse c
,D. cDiabetes cmellitus c- ccorrect cansC. cAlcohol cabuse c
The cpatient cwith calcohol cabuse ccould cdevelop cpancreatitis cas ca ccomplication,
cwhich cwould cincrease cthe cserum camylase c(normal c30-122 cU/L) cand cserum clipase
c(normal c31-186 cU/L) clevels cas cshown.
The chealth ccare cprovider corders clactulose cfor ca cpatient cwith chepatic
cencephalopathy. cThe cnurse cwill cmonitor cfor ceffectiveness cof cthis cmedication cfor
cthis cpatient cby cassessing cwhich cof cthe cfollowing?
A. cRelief cof cconstipation
B. cRelief cof cabdominal cpain
C. cDecreased cliver cenzymes
D. cDecreased cammonia clevels c- ccorrect cansD. cDecreased cammonia clevels c
Hepatic cencephalopathy cis ca ccomplication cof cliver cdisease cand cis cassociated cwith
celevated cserum cammonia clevels. c*Lactulose ctraps cammonia cin cthe cintestinal ctract.
cIts claxative ceffect cthen cexpels cthe cammonia cfrom cthe ccolon*, cresulting cin
cdecreased cserum cammonia clevels cand ccorrection cof chepatic cencephalopathy.
What cdoes cvomiting ccause? c
A. cAlkalosis
B. cAcidosis c- ccorrect cansA. cAlkalosis
What cdoes cdiarrhea ccause? c
A. cAlkalosis
B. cAcidosis c- ccorrect cansB. cAcidosis
A cpatient cwith cheart cfailure cand ccirrhosis chas cboth cspironolactone c(Aldactone) cand
cfurosemide c(Lasix) cscheduled cfor c08:00. cAt c06:00 chis cserum cpotassium clevel cwas
c3.0 cmEq/L c(reference crange c3.5 c- c5.0 cmEq/L).
What caction cshould cthe cnurse ctake?
A. cGive cboth cdrugs cas cscheduled.
B. cAdminister cthe cspironolactone cbut chold cthe
furosemide.
C. cAdminister cthe cfurosemide cbut chold cthe
spironolactone.
D. cHold cboth cdrugs cuntil ctalking cwith cthe cpatient's cdoctor. c- ccorrect cansB.
cAdminister cthe cspironolactone cbut chold cthe
furosemide.
,The canti-aldosterone cdrug cis ca cK+ csparring cdiuretic. cAldosterone ccauses csodium
cretention cand cpotassium cexcretion cso cit cwastes cK+. cSpironolactone cis can canti-
aldosterone cdiuretic cso cit ccauses cdiuresis cwithout cwasting cpotassium.
Your cpatient chas cjaundice. cHis cserum cbilirubin clab cresults cshow:
- cUnconjugated c(indirect) cbilirubin cis celevated
- cConjugated c(direct) cbilirubin cis cnormal
This ccould cbe cthe cresult cof:
A. cA cbile cduct cobstruction
B. cHepatitis cB
C. cSickle ccell ccrisis
D. cTylenol cinduced chepatitis c- ccorrect cansC. cSickle ccell ccrisis
Ms. cJemima cPuddleduck chas ca cdiagnosis cof ccomplete cobstructive cjaundice cdue cto
cgallstones cin cher ccommon cbile cduct. cThe cnurse cwould cexpect cto cobserve cfor:
A. cBrown cstools cand cstraw cyellow curine
B. cGreen cstools cand cpale cyellow curine
C. cMelena
D. cClay ccolored cstools cand cdark corange curine c- ccorrect cansD. cClay ccolored cstools
cand cdark corange curine
A cTrans-jugular cIntrahepatic cPortosystemic cShunt c(TIPS) cis ca cprocedure cthat chelps
cto cprevent cportal chypertension cby ccreating ca cshunt cthat cbypasses cthe cliver cby
cshunting cblood cfrom cthe cportal cvein cto cthe chapatic cvein. cWhy cmight chepatic
cencephalopathy cbecome cworst cafter cthis cprocedure? c- ccorrect cansThe cliver cis cnot
cconverting cammonia cto curea cand cso chepatic cencephalopathy cmay cworsen.
What cis cLactulose c(Cephulac)? c- ccorrect cansA cdrug cthat ctraps cammonia cin cthe
cgut, cwhere cit cis cexpelled cfrom cthe ccolon.
What care csome cways cto crelieve cthe cascites cassociated cwith ccirrhosis cof cthe cliver?
c- ccorrect cans-HOB celevated cto crelieve cDyspnea c
-Measure cabdominal cgirth cat cthe csame cplace ceach ctime cand cat cwidest cpoint c(use
cmarker cto cmark)
-Administer c25% calbumin cto cincrease concotic cpressure
-Administer cpotassium csparring cdiuretics clike cspironolactone c(Aldactone) cand
cpotassium cwasting cdiuretics clike cfurosemide c(Lasix) c
-Paracentesis c(draining cfluid cfrom cthe cperitoneum)
-Fluid crestriction/sodium crestriction/I/O/Daily cweights/Dyspnea/O2
Diagnostic cstudies cof cCirrhosis cwould cshow c_______ cliver cenzymes, c____ calbumin,
c______ ctotal cserum cbilirubin cand c_____ cPT/INR? c
Choose cfrom: c
, A. cHigh
B. cLow
C. cExtended c- ccorrect canshigh, clow, chigh, cdecreased, cextended
Ms. cJemima cPuddleduck chas ca cdiagnosis cof ccomplete c*obstructive cjaundice* cdue
cto cgallstones cin cher ccommon cbile cduct. cThe cnurse cwould cexpect cto cobserve cfor:
A. can celevated cserum ctotal cbilirubin
B. can celevated cserum cunconjugated c(indirect) cBilirubin
C. cAn celevated cserum cconjugated c(direct) cBilirubin
D. cBoth cA cand cC c- ccorrect cansA cand cC c(makes csense cthat cif cobstruction coccurs
cafter cthe cliver, cwhere cbilirubin cis cconjugated, cthat cit cwould cnot cbe celevated, cbut
cbook csays call c3 cwould cbe con cpage c1059) c
Post-hepatic c-or- cObstructive cJaundice cis ca c*pathology cthat coccurs cafter cthe
cconjugation cof cbilirubin cin cthe cliver*. c
*ASK: cpage c1059-both cunconjugated cand cconjugated care cobstructed*
During cassessment cof ca cpatient cwith cobstructive cjaundice, cthe cnurse cwould cexpect
cto cfind?
a. cclay-colored cstools.
b. cdark curine cand cstools.
c. cpyrexia cand csevere cpruritus.
d. celevated curinary curobilinogen. c- ccorrect cans*a. cclay-colored cstools.*
A cpatient chas cbeen ctold cthat cshe chas celevated cliver cenzymes ccaused cby cNAFLD.
cWhat cshould cthe cnursing cteaching cplan cinclude?
A. cHaving cgenetic ctesting cdone
B. cRecommending ca cheart-healthy cdiet
C. cThe cnecessity cto creduce cweight crapidly
D. cAvoiding calcohol cuntil cliver cenzymes creturn cto cnormal c- ccorrect cansNAFLD ccan
cprogress cto cliver ccirrhosis. cThere cis cno cdefinitive ctreatment, cand ctherapy cis
cdirected cat creduction cof crisk cfactors. cThese cmeasures cinclude ctreatment cof
cdiabetes, creduction cin cbody cweight, cand celimination cof charmful cmedications. cFor
cthose cwho care coverweight, cweight creduction cis cimportant. cWeight closs cimproves
cinsulin csensitivity cand creduces cliver cenzyme clevels. cNo cspecific cdietary ctherapy cis
crecommended, cbut ca cheart-healthy cdiet cas crecommended cby cthe cAmerican cHeart
cAssociation cis cappropriate....
What cis cmost cindicative cof cend-stage ccirrhosis?
A. cALT cand cAST clevels cfive ctimes cthe cnormal cvalue
QUESTIONS AND CORRECT
ANSWERS
When cplanning ccare cfor ca cpatient cwith ccirrhosis, cthe cnurse cwill cgive chighest cpriority
cto cwhich cof cthe cfollowing cnursing cdiagnoses?
A. cImbalanced cnutrition: cless cthan cbody crequirements
B. cImpaired cskin cintegrity crelated cto cedema, cascites, cand cpruritus
C. cExcess cfluid cvolume crelated cto cportal chypertension cand chyperaldosteronism c
D. cIneffective cbreathing cpattern crelated cto cpressure con cdiaphragm cand creduced
clung cvolume c- ccorrect cansD. cIneffective cbreathing cpattern crelated cto cpressure con
cdiaphragm cand creduced clung cvolume c
ABC
A c54-year-old cpatient cadmitted cwith cdiabetes cmellitus, cmalnutrition, costeomyelitis,
cand calcohol cabuse chas ca cserum camylase clevel cof c280 cU/L cand ca cserum clipase
clevel cof c310 cU/L. cTo cwhich cof cthe cfollowing cdiagnoses cdoes cthe cnurse cattribute
cthese cfindings?
A. cMalnutrition
B. cOsteomyelitis
C. cAlcohol cabuse c
,D. cDiabetes cmellitus c- ccorrect cansC. cAlcohol cabuse c
The cpatient cwith calcohol cabuse ccould cdevelop cpancreatitis cas ca ccomplication,
cwhich cwould cincrease cthe cserum camylase c(normal c30-122 cU/L) cand cserum clipase
c(normal c31-186 cU/L) clevels cas cshown.
The chealth ccare cprovider corders clactulose cfor ca cpatient cwith chepatic
cencephalopathy. cThe cnurse cwill cmonitor cfor ceffectiveness cof cthis cmedication cfor
cthis cpatient cby cassessing cwhich cof cthe cfollowing?
A. cRelief cof cconstipation
B. cRelief cof cabdominal cpain
C. cDecreased cliver cenzymes
D. cDecreased cammonia clevels c- ccorrect cansD. cDecreased cammonia clevels c
Hepatic cencephalopathy cis ca ccomplication cof cliver cdisease cand cis cassociated cwith
celevated cserum cammonia clevels. c*Lactulose ctraps cammonia cin cthe cintestinal ctract.
cIts claxative ceffect cthen cexpels cthe cammonia cfrom cthe ccolon*, cresulting cin
cdecreased cserum cammonia clevels cand ccorrection cof chepatic cencephalopathy.
What cdoes cvomiting ccause? c
A. cAlkalosis
B. cAcidosis c- ccorrect cansA. cAlkalosis
What cdoes cdiarrhea ccause? c
A. cAlkalosis
B. cAcidosis c- ccorrect cansB. cAcidosis
A cpatient cwith cheart cfailure cand ccirrhosis chas cboth cspironolactone c(Aldactone) cand
cfurosemide c(Lasix) cscheduled cfor c08:00. cAt c06:00 chis cserum cpotassium clevel cwas
c3.0 cmEq/L c(reference crange c3.5 c- c5.0 cmEq/L).
What caction cshould cthe cnurse ctake?
A. cGive cboth cdrugs cas cscheduled.
B. cAdminister cthe cspironolactone cbut chold cthe
furosemide.
C. cAdminister cthe cfurosemide cbut chold cthe
spironolactone.
D. cHold cboth cdrugs cuntil ctalking cwith cthe cpatient's cdoctor. c- ccorrect cansB.
cAdminister cthe cspironolactone cbut chold cthe
furosemide.
,The canti-aldosterone cdrug cis ca cK+ csparring cdiuretic. cAldosterone ccauses csodium
cretention cand cpotassium cexcretion cso cit cwastes cK+. cSpironolactone cis can canti-
aldosterone cdiuretic cso cit ccauses cdiuresis cwithout cwasting cpotassium.
Your cpatient chas cjaundice. cHis cserum cbilirubin clab cresults cshow:
- cUnconjugated c(indirect) cbilirubin cis celevated
- cConjugated c(direct) cbilirubin cis cnormal
This ccould cbe cthe cresult cof:
A. cA cbile cduct cobstruction
B. cHepatitis cB
C. cSickle ccell ccrisis
D. cTylenol cinduced chepatitis c- ccorrect cansC. cSickle ccell ccrisis
Ms. cJemima cPuddleduck chas ca cdiagnosis cof ccomplete cobstructive cjaundice cdue cto
cgallstones cin cher ccommon cbile cduct. cThe cnurse cwould cexpect cto cobserve cfor:
A. cBrown cstools cand cstraw cyellow curine
B. cGreen cstools cand cpale cyellow curine
C. cMelena
D. cClay ccolored cstools cand cdark corange curine c- ccorrect cansD. cClay ccolored cstools
cand cdark corange curine
A cTrans-jugular cIntrahepatic cPortosystemic cShunt c(TIPS) cis ca cprocedure cthat chelps
cto cprevent cportal chypertension cby ccreating ca cshunt cthat cbypasses cthe cliver cby
cshunting cblood cfrom cthe cportal cvein cto cthe chapatic cvein. cWhy cmight chepatic
cencephalopathy cbecome cworst cafter cthis cprocedure? c- ccorrect cansThe cliver cis cnot
cconverting cammonia cto curea cand cso chepatic cencephalopathy cmay cworsen.
What cis cLactulose c(Cephulac)? c- ccorrect cansA cdrug cthat ctraps cammonia cin cthe
cgut, cwhere cit cis cexpelled cfrom cthe ccolon.
What care csome cways cto crelieve cthe cascites cassociated cwith ccirrhosis cof cthe cliver?
c- ccorrect cans-HOB celevated cto crelieve cDyspnea c
-Measure cabdominal cgirth cat cthe csame cplace ceach ctime cand cat cwidest cpoint c(use
cmarker cto cmark)
-Administer c25% calbumin cto cincrease concotic cpressure
-Administer cpotassium csparring cdiuretics clike cspironolactone c(Aldactone) cand
cpotassium cwasting cdiuretics clike cfurosemide c(Lasix) c
-Paracentesis c(draining cfluid cfrom cthe cperitoneum)
-Fluid crestriction/sodium crestriction/I/O/Daily cweights/Dyspnea/O2
Diagnostic cstudies cof cCirrhosis cwould cshow c_______ cliver cenzymes, c____ calbumin,
c______ ctotal cserum cbilirubin cand c_____ cPT/INR? c
Choose cfrom: c
, A. cHigh
B. cLow
C. cExtended c- ccorrect canshigh, clow, chigh, cdecreased, cextended
Ms. cJemima cPuddleduck chas ca cdiagnosis cof ccomplete c*obstructive cjaundice* cdue
cto cgallstones cin cher ccommon cbile cduct. cThe cnurse cwould cexpect cto cobserve cfor:
A. can celevated cserum ctotal cbilirubin
B. can celevated cserum cunconjugated c(indirect) cBilirubin
C. cAn celevated cserum cconjugated c(direct) cBilirubin
D. cBoth cA cand cC c- ccorrect cansA cand cC c(makes csense cthat cif cobstruction coccurs
cafter cthe cliver, cwhere cbilirubin cis cconjugated, cthat cit cwould cnot cbe celevated, cbut
cbook csays call c3 cwould cbe con cpage c1059) c
Post-hepatic c-or- cObstructive cJaundice cis ca c*pathology cthat coccurs cafter cthe
cconjugation cof cbilirubin cin cthe cliver*. c
*ASK: cpage c1059-both cunconjugated cand cconjugated care cobstructed*
During cassessment cof ca cpatient cwith cobstructive cjaundice, cthe cnurse cwould cexpect
cto cfind?
a. cclay-colored cstools.
b. cdark curine cand cstools.
c. cpyrexia cand csevere cpruritus.
d. celevated curinary curobilinogen. c- ccorrect cans*a. cclay-colored cstools.*
A cpatient chas cbeen ctold cthat cshe chas celevated cliver cenzymes ccaused cby cNAFLD.
cWhat cshould cthe cnursing cteaching cplan cinclude?
A. cHaving cgenetic ctesting cdone
B. cRecommending ca cheart-healthy cdiet
C. cThe cnecessity cto creduce cweight crapidly
D. cAvoiding calcohol cuntil cliver cenzymes creturn cto cnormal c- ccorrect cansNAFLD ccan
cprogress cto cliver ccirrhosis. cThere cis cno cdefinitive ctreatment, cand ctherapy cis
cdirected cat creduction cof crisk cfactors. cThese cmeasures cinclude ctreatment cof
cdiabetes, creduction cin cbody cweight, cand celimination cof charmful cmedications. cFor
cthose cwho care coverweight, cweight creduction cis cimportant. cWeight closs cimproves
cinsulin csensitivity cand creduces cliver cenzyme clevels. cNo cspecific cdietary ctherapy cis
crecommended, cbut ca cheart-healthy cdiet cas crecommended cby cthe cAmerican cHeart
cAssociation cis cappropriate....
What cis cmost cindicative cof cend-stage ccirrhosis?
A. cALT cand cAST clevels cfive ctimes cthe cnormal cvalue
