28. The client asks how he contracted hepatitis A. He
reports all of the following. Which one is most
likely related to hepatitis A?
2. He ate oysters his roommate brought home from
a fishing trip.
3. He stepped on a nail two weeks ago.
4. He donated blood two weeks before he got sick.
29. A client has had a liver biopsy. After the
procedure, the nurse should position him on his
right side with a pillow under his rib cage. What is
the primary reason for this position?
1. To immobilize the diaphragm
2. To facilitate full chest expansion
3. To minimize the danger of aspiration
4. To reduce the likelihood of bleeding
30. A client with cirrhosis is about to have a
paracentesis for relief of ascites. Which activity is
essential prior to the procedure?
1. Administer thorough mouth care.
2. Ask the client to empty his bladder.
3. Be sure his bowels have moved recently.
4. Have the client bathe with betadine.
31. The client has severe liver disease. Which of
the following observations is most indicative of
serious problems?
1. The client has generalized urticaria.
2. The client is “confused” and can no longer
write his name legibly.
3. The client is jaundiced.
4. The client has ecchymotic areas on his arms.
Nursing Care of Clients with Disorders
of the Gallbladder
A 45-year-old client is suspected of having cholecystitis.
119. When describing the discomfort to the nurse, the
client is most likely to indicate that the pain worsens at
which time?
[ ] 1. Shortly after eating
[ ] 2. When the stomach is empty
[ ] 3. After periods of activity
[ ] 4. Before rising in the morning
120. If this client is typical of others with cholecystitis,
besides localized pain, the client may describe feeling pain
that is referred to which area?
[ ] 1. Right shoulder
[ ] 2. Midepigastrium
[ ] 3. Neck or jaw
[ ] 4. Left upper arm
121. If the cause of the client’s infl amed gallbladder is
gallstones, the nurse would anticipate the laboratory data
to indicate which fi nding?
[ ] 1. Low red blood cell count
[ ] 2. Low hemoglobin level
[ ] 3. Elevated cholesterol level
[ ] 4. Elevated serum albumin level
122. If gallstones obstruct the fl ow of bile, how would
the nurse expect the client’s stools to appear?
[ ] 1. Black and tarry
[ ] 2. Light clay-colored
[ ] 3. Brown with bloody mucus
[ ] 4. Greenish yellow
123. When the dietitian has fi nished instructing the client
about a low-fat diet, the nurse knows that the client
requires additional teaching based on which statement?
[ ] 1. “I can eat chicken that has been broiled.”
[ ] 2. “Because fi sh is good for me, I’ll still get to eat a
lot of baked fi sh.”
[ ] 3. “I can have a hamburger and fries when I go out
with friends.”
[ ] 4. “I guess I’ll eat more roasted turkey for dinner.”
Because the client’s gallbladder was unable to concentrate
and excrete bile, it could not be visualized by cholecystography.
The physician orders an ultrasound of the gallbladder.
The nurse explains the scheduled procedure to the client.
124. Which comment indicates that the client has an
accurate understanding of the preparation necessary for the
procedure?
[ ] 1. “Preparation involves withholding food for
approximately 8 to 12 hours.”
[ ] 2. “I’ll need to drink a container of barium just before
the X-ray.”
[ ] 3. “I’ll be allowed to eat a large test meal the night
before the X-ray.”
[ ] 4. “Just before the test, they’ll insert a large needle
into one of my arm veins.”
Ultrasound of the client’s gallbladder reveals several
stones in the common bile duct. A laparoscopic cholecystectomy
is scheduled.
125. Which statements made by the nurse provide the
best explanations of this procedure? Select all that apply.
[ ] 1. The procedure will require moderate sedation.
[ ] 2. The surgery will require a long period of gastric
decompression.
[ ] 3. The abdomen will be infl ated with carbon dioxide
to provide a maximum view.
[ ] 4. There will be four small puncture sites.
[ ] 5. Most clients return home the evening after the
procedure.
[ ] 6. A T-tube is inserted to drain bile until the surgical
wound heals.
Another client comes to the clinic with signs and symptoms
related to gallbladder disease but is not a candidate for a
laparoscopic cholecystectomy. The surgeon schedules an
open cholecystectomy.
The client returns from surgery with a nasogastric tube,
a T-tube for bile drainage, and a Jackson-Pratt tube for
wound drainage in place.
126. Immediately after surgery, the nurse assesses the
drainage from the T-tube. Which assessment fi nding best
indicates that the drainage color is normal at this time?
[ ] 1. The drainage is dark red or pale pink.
[ ] 2. The drainage is clear or transparent.
[ ] 3. The drainage is bright red or orange.
[ ] 4. The drainage is greenish yellow or brown.
127. The nurse is required to take which actions when
emptying the drainage receptacle of the client’s Jackson-
Pratt closed-wound drain? Select all that apply.
[ ] 1. Empty the drainage into a measuring container.
[ ] 2. Adjust the suction setting to low continuous suction.
[ ] 3. Squeeze the receptacle to expel air.
[ ] 4. Release the roller clamp.
[ ] 5. Cover the vent.
[ ] 6. Stabilize the drainage tube.
128. The nurse should anticipate implementing which
interventions to manage this client’s T-tube? Select all that
apply.
[ ] 1. Record the amount of drainage from the T-tube.
[ ] 2. Unclamp the T-tube at hourly intervals.
[ ] 3. Keep the T-tube drainage bag parallel with the
incision.
[ ] 4. Inspect the skin around the tube for irritation.
[ ] 5. Maintain the client in Fowler’s position.
[ ] 6. Notify the physician if the drainage changes color.
129. When the nurse assesses the T-tube in the early
postoperative period, which fi nding requires immediate
action?
[ ] 1. The drainage bag is hanging below the abdomen.
[ ] 2. The drainage tubing is currently clamped.
[ ] 3. The drainage tube is taped to the client’s right side.
[ ] 4. The drainage volume was 100 mL in the past 6 hours.
130. When the client begins to consume food again,
which routine for clamping and unclamping the T-tube
should the nurse plan to follow?
[ ] 1. Unclamp the tube during the day.
[ ] 2. Unclamp the tube during the night.
[ ] 3. Unclamp the tube for 2 hours after eating.
[ ] 4. Unclamp the tube for 2 hours before eating.
131. How would the nurse reestablish negative pressure
within the Jackson-Pratt tube when emptying the drainage
bulb reservoir?
[ ] 1. By compressing the bulb reservoir and closing the
drainage valve
[ ] 2. By opening the drainage valve, allowing the bulb
to fi ll with air
[ ] 3. By fi lling the bulb reservoir with sterile normal
saline solution
[ ] 4. By securing the bulb reservoir to the skin near the
wound
Nursing Care of Clients with Disorders
of the Liver
A 20-year-old college student goes to the university
health service after developing a sudden onset of fl ulike
symptoms.
132. When the health nurse monitors the client’s laboratory
test results, which elevated level would strongly suggest
a possible liver disorder?
[ ] 1. Serum potassium
[ ] 2. Serum creatinine
[ ] 3. Blood urea nitrogen (BUN)
[ ] 4. Alanine aminotransferase (ALT)
The physician determines that the college student has
hepatitis A.
133. When the client asks the nurse how the hepatitis A
was acquired, what is the best answer?
[ ] 1. Fecal-oral route
[ ] 2. Insect carriers
[ ] 3. Infected blood
[ ] 4. Wound drainage
An infection control nurse is consulted on measures for
reducing the potential transmission of the hepatitis A virus
to others.
134. On the basis of the routes of transmission for this
disease, which infection control measure is essential to
include in the client’s care plan?
[ ] 1. Wear gloves whenever entering the client’s room.
[ ] 2. Don a mask and gown when providing direct care.
[ ] 3. Maintain the client in a private room at all times.
[ ] 4. Perform vigorous hand washing after leaving the
room.
Several of the college student’s friends call the health
service because they are concerned about their own risks
for acquiring hepatitis A.
135. To prevent the spread of hepatitis A, the nurse
correctly advises that close contacts receive which
medication?
[ ] 1. An antibiotic
[ ] 2. Serum immunoglobulin
[ ] 3. Hepatitis vaccine
[ ] 4. An anti-infl ammatory drug
A 23-year-old develops jaundice and goes to the public
health department. Testing reveals that the cause of the
client’s jaundice is hepatitis B. The nurse gathers information
regarding the client’s social history.
136. What information from the client’s history indicates
a predisposition for acquiring hepatitis B? Select all that
apply.
[ ] 1. The client moved from Europe.
[ ] 2. The client is a sexually active homosexual.
[ ] 3. The client abuses alcohol.
[ ] 4. The client works in a restaurant.
[ ] 5. The client has had a blood transfusion.
[ ] 6. The client was punctured with an unused needle.
137. Which measure is most appropriate if a nurse who
has not received a series of vaccinations for hepatitis B
experiences a needle-stick injury while caring for this
client?
[ ] 1. Obtain immediate immunization with hepatitis B
vaccine.
[ ] 2. Receive hepatitis B immunoglobulin within 1 week.
[ ] 3. Take penicillin (Pentam) for a minimum of 10 days.
[ ] 4. Scrub the puncture site with diluted household
bleach.
138. The nurse informs the client that because of the
disease, it is essential to avoid which activity for life?
[ ] 1. Sexual activity
[ ] 2. Donating blood
[ ] 3. Drinking alcohol
[ ] 4. Traveling to foreign countries
A 60-year-old client seeks medical attention with symptoms
of vomiting blood and passing bloody stools. The
tentative diagnosis is cirrhosis of the liver.
139. Which information in the client’s health history
most likely relates to the development of cirrhosis? Select
all that apply.
[ ] 1. The client drinks a fi fth of whiskey daily.
[ ] 2. The client smokes two packs of cigarettes per day.
[ ] 3. The client has a history of pancreatitis.
[ ] 4. The client has been taking antihypertensive medications
for the past 15 years.
[ ] 5. The client eats poorly as a consequence of being
homeless for 5 years.
[ ] 6. The client has been exposed to asbestos.
140. If the client’s cirrhosis is advanced, what will the
nurse expect to fi nd during the initial health assessment?
Select all that apply.
[ ] 1. Laboratory results revealing an elevated serum
cholesterol level
[ ] 2. The presence of spiderlike blood vessels on
the skin
[ ] 3. An unusually large and edematous abdomen
[ ] 4. An abnormally high blood glucose level
[ ] 5. Skin that is jaundiced
[ ] 6. Vein engorgement around the umbilicus
141. Which assessment fi nding indicates that the client is
bleeding from somewhere in the upper GI tract?
[ ] 1. The client has midepigastric pain.
[ ] 2. The client states, “I feel nauseated.”
[ ] 3. The client’s stools are black and sticky.
[ ] 4. The client’s abdomen is distended and boardlike.
The physician considers performing a liver biopsy to confi
rm a diagnosis of cirrhosis.
142. If the liver biopsy is performed, the nurse must
monitor the client immediately after the procedure for
which potential complication?
[ ] 1. Hemorrhage
[ ] 2. Infection
[ ] 3. Blood clots
[ ] 4. Collapsed lung
143. After a liver biopsy, which nursing order is most
appropriate to add to the client’s care plan?
[ ] 1. Ambulate the client twice each shift.
[ ] 2. Keep the client in high Fowler’s position.
[ ] 3. Position the client on the right side.
[ ] 4. Elevate the client’s legs on two pillows.
The physician orders magnetic resonance imaging (MRI)
instead of the liver biopsy to confi rm the diagnosis.
144. Before the magnetic resonance imaging (MRI)
study is performed, which nursing action is essential?
[ ] 1. Administering a pretest sedative
[ ] 2. Removing the client’s dental bridge
[ ] 3. Asking if the client is allergic to opiates
[ ] 4. Inserting a Foley retention catheter
The care plan indicates that the nurse should monitor the
client with cirrhosis each day for signs and symptoms of
ascites.
145. To implement this nursing order, which nursing
action is most appropriate?
[ ] 1. Reviewing the client’s serum bilirubin levels
[ ] 2. Monitoring the client for vomiting and diarrhea
[ ] 3. Pressing on the client’s abdomen testing for
rebound tenderness
[ ] 4. Measuring the client’s abdominal circumference
Magnetic resonance imaging (MRI) confi rms the diagnosis
of hepatic cirrhosis and reveals a large amount of fl uid in
the peritoneal cavity. A paracentesis is planned.
146. Which nursing action is most appropriate before
assisting with the paracentesis?
[ ] 1. Asking the client to void
[ ] 2. Withholding food and water
[ ] 3. Clipping hair from the client’s abdomen
[ ] 4. Placing the crash cart outside the client’s room
147. After the paracentesis has been performed, which
nursing responsibility is essential?
[ ] 1. Increasing the client’s oral fl uid intake
[ ] 2. Recording the volume of withdrawn fl uid
[ ] 3. Administering a prescribed analgesic
[ ] 4. Encouraging the client to deep-breathe
The client’s I.V. line has infi ltrated and has to be removed
and restarted in a new site. The licensed practical nurse
(LPN) collaborates with the registered nurse (RN) about
assisting with these procedures.
148. Which nursing action is most appropriately delegated
to the LPN?
[ ] 1. Clean the new insertion site with an antiseptic.
[ ] 2. Flush the I.V. line with no more than 1 mL at any
given time.
[ ] 3. Obtain a vial of vitamin K to keep at the bedside.
[ ] 4. Apply pressure to the old insertion site after I.V.
removal.
149. Which laboratory result, if elevated, is most indicative
that the client may develop hepatic encephalopathy?
[ ] 1. Serum creatinine
[ ] 2. Serum bilirubin
[ ] 3. Blood ammonia
[ ] 4. Blood urea nitrogen
150. Which assessment fi nding best indicates that the
cirrhotic client’s condition is worsening?
[ ] 1. The client is diffi cult to arouse.
[ ] 2. The client’s urine output is 100 mL/hour.
[ ] 3. The client develops pancreatitis.
[ ] 4. The client’s breath smells fruity.
The seriousness of the client’s condition is explained to the
client’s spouse. The spouse is prepared for the possibility
of the client’s death.
151. When the client’s spouse begins crying while recalling
various signifi cant events they shared together, which
nursing action is most therapeutic at this time?
[ ] 1. Offer to call a close family member.
[ ] 2. Listen to the spouse’s expressions of thoughts.
[ ] 3. Suggest calling a clergyman from their church.
[ ] 4. Ask about the spouse’s future plans.
The Client with Cholecystitis