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CHAPTER 6
QUESTION ANSWER

1. A nurse is working with a patient who has chronic A) Use glycerin suppositories on a regular basis.
constipation. What should be included in patient B) Limit physical activity in order to promote bowel peristalsis.
teaching to promote normal bowel function? C) Consume high-residue, high-fiber foods.
D) Resist the urge to defecate until the urge becomes intense.

2. A nurse is preparing to provide care for a patient whose A) Watery with blood and mucus
exacerbation of ulcerative colitis has required hospital B) Hard and black or tarry
admission. During an exacerbation of this health C) Dry and streaked with blood
problem, the nurse would anticipate that the patients D) Loose with visible fatty streaks
stools will have what characteristics?

3. A patient has had an ileostomy created for the A) Apply antibiotic ointment as ordered after cleaning the
treatment of irritable bowel disease and the patient is stoma.
now preparing for discharge. What should the patient B) Apply a skin barrier to the peristomal skin prior to
be taught about changing this device in the home applying the pouch.
setting? C) Dispose of the clamp with each bag change.
D) Cleanse the area surrounding the stoma with alcohol or
chlorhexidine.

4. A patient admitted with acute diverticulitis has A) Administer a Fleet enema as ordered and remain with the
experienced a sudden increase in temperature and patient.
complains of a sudden onset of exquisite abdominal B) Contact the primary care provider promptly and report
tenderness. The nurses rapid assessment reveals that these signs of perforation.
the patients abdomen is uncharacteristically rigid on C) Position the patient supine and insert an NG tube.
palpation. What is the nurses best response? D) Page the primary care provider and report that the patient
may be obstructed.

5. A 35-year-old male patient presents at the emergency A) Insertion of a nasogastric tube

department with symptoms of a small bowel B) Insertion of a central venous catheter
obstruction. In collaboration with the primary care C) Administration of a mineral oil enema
provider, what intervention should the nurse prioritize? D) Administration of a glycerin suppository and an oral laxative

6. A patient admitted with inflammatory bowel disease A) Spinach

asks the nurse for help with menu selections. What B) Tofu
menu selection is most likely the best choice for this C) Multigrain bagel
patient? D) Blueberries

7. A patient is admitted to the medical unit with a A) Ineffective Tissue Perfusion Related to Bowel Ischemia
diagnosis of intestinal obstruction. When planning this B) Imbalanced Nutrition: Less Than Body Requirements
patients care, which of the following nursing diagnoses Related to Impaired Absorption
should the nurse prioritize? C) Anxiety Related to Bowel Obstruction and Subsequent
Hospitalization
D) Impaired Skin Integrity Related to Bowel Obstruction

8. A nurse is presenting an educational event to a local A) High levels of alcohol consumption

community group. When speaking about colorectal B) History of bowel obstruction
cancer, what risk factor should the nurse cite? C) History of diverticulitis
D) Longstanding psychosocial stress

9. A patients screening colonoscopy revealed the A) Adherence to a high-fiber diet will help the polyps resolve.
presence of numerous polyps in the large bowel. What B) The patient should be assured that these are a normal, age-
principle should guide the subsequent treatment of this related physiologic change.
patients health problem? C) The patients polyps constitute a risk factor for cancer.
D) The presence of polyps is associated with an increased risk
of bowel obstruction.

10. A nursing instructor is discussing hemorrhoids with the A) A 45-year-old teacher who stands for 6 hours per day
nursing class. Which patients would the nursing B) A pregnant woman at 28 weeks gestation
instructor identify as most likely to develop C) A 37-year-old construction worker who does heavy lifting
hemorrhoids? D) A 60-year-old professional who is under stress

11. A nurse is planning discharge teaching for a 21-year-old A) The familys ability to take care of the patients special diet
patient with a new diagnosis of ulcerative colitis. When needs
planning family assessment, the nurse should B) The familys ability to monitor the patients changing health
recognize that which of the following factors will likely status
have the greatest impact on the patients coping after C) The familys ability to provide emotional support
discharge? D) The familys ability to manage the patients medication
regimen

12. An older adult who resides in an assisted living facility A) Encourage the patient to take stool softener daily.
has sought care from the nurse because of recurrent B) Assess the patients food and fluid intake.
episodes of constipation. Which of the following actions C) Assess the patients surgical history.
should the nurse first perform? D) Encourage the patient to take fiber supplements.
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13. A 16-year-old presents at the emergency department A) Imbalanced Nutrition: Less Than Body Requirements
complaining of right lower quadrant pain and is Related to Decreased Oral Intake
subsequently diagnosed with appendicitis. When B) Risk for Infection Related to Possible Rupture of
planning this patients nursing care, the nurse should Appendix
prioritize what nursing diagnosis? C) Constipation Related to Decreased Bowel Motility and
Decreased Fluid Intake
D) Chronic Pain Related to Appendicitis

14. A nurse is talking with a patient who is scheduled to A) Reassure the patient that the procedure is relatively low risk
have a hemicolectomy with the creation of a colostomy. and that patients are usually successful
The patient admits to being anxious, and has many in adjusting to an ostomy.
questions concerning the surgery, the care of a stoma, B) Provide the patient with educational materials that match
and necessary lifestyle changes. Which of the following the patients learning style.
nursing actions is most appropriate? C) Encourage the patient to write down these concerns and
questions to bring forward to the surgeon.
D) Maintain an open dialogue with the patient and
facilitate a referral to the wound-ostomy-continence
(WOC) nurse

15. A nurse is caring for a patient with constipation whose A) Limit your fluid intake temporarily so you dont get diarrhea.
primary care provider has recommended senna B) Avoid taking the drug on a long-term basis.
(Senokot) for the management of this condition. The C) Make sure to take a multivitamin with each dose.
nurse should provide which of the following education D) Take this on an empty stomach to ensure maximum effect.
points?

16. The nurse is caring for a patient who is undergoing A) Recurrent constipation coupled with weight loss
diagnostic testing for suspected malabsorption. When B) Foul-smelling diarrhea that contains fat
taking this patients health history and performing the C) Fever accompanied by a rigid, tender abdomen
physical assessment, the nurse should recognize what D) Bloody bowel movements accompanied by fecal
finding as most consistent with this diagnosis? incontinence

17. A nurse is caring for a patient admitted with symptoms A) Acyclovir (Zovirax)
of an anorectal infection; cultures indicate that the B) Doxycycline (Vibramycin)
patient has a viral infection. The nurse should anticipate C) Penicillin (penicillin
the administration of what drug? D) Metronidazole (Flagyl)

18. A nurse caring for a patient with colorectal cancer is A) To treat any undiagnosed infections
preparing the patient for upcoming surgery. The nurse B) To reduce intestinal bacteria levels
administers cephalexin (Keflex) to the patient and C) To reduce bowel motility
explains what rationale? D) To reduce abdominal distention postoperatively

19. A nurse is teaching a group of adults about screening A) Development of new hemorrhoids
and prevention of colorectal cancer. The nurse should B) Abdominal bloating and flank pain
describe which of the following as the most common C) Unexplained weight gain
sign of possible colon cancer? D) Change in bowel habits

20. A nurse caring for a patient with a newly created A) Facilitate a referral to the wound-ostomy-continence (WOC)
ileostomy assesses the patient and notes that the nurse.
patient has had not ostomy output for the past 12 hours. B) Report signs and symptoms of obstruction to the
The patient also complains of worsening nausea. What physician.
is the nurses priority action? C) Encourage the patient to mobilize in order to enhance
motility.
D) Contact the physician and obtain a swab of the stoma for
culture.

21. A nurse is working with a patient who is learning to care A) Aim to eventually empty the pouch every 90 minutes.
for a continent ileostomy (Kock pouch). Following the B) Avoid emptying the pouch until it is visibly full.
initial period of healing, the nurse is teaching the patient C) Insert the catheter approximately 5 cm into the pouch.
how to independently empty the ileostomy. The nurse D) Aspirate the contents of the pouch using a 60 mL piston
should teach the patient to do which of the following syringe.
actions?

22. A nurse is providing care for a patient who has a A) Patient will accurately identify foods that trigger
diagnosis of irritable bowel syndrome (IBS). When symptoms.
planning this patients care, the nurse should collaborate B) Patient will demonstrate appropriate care of his ileostomy.
with the patient and prioritize what goal? C) Patient will demonstrate appropriate use of standard
infection control precautions.
D) Patient will adhere to recommended guidelines for mobility
and activity.

23. A patient has been experiencing disconcerting GI A) Annual screening colonoscopies

symptoms that have been worsening in severity. B) Adherence to recommended immunization schedules
Following medical assessment, the patient has been C) Regular blood pressure monitoring
diagnosed with lactose intolerance. The nurse should D) Frequent screening for osteoporosis
recognize an increased need for what form of health
promotion?
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24. An older adult has a diagnosis of Alzheimers disease A) Keep a food diary to determine the foods that exacerbate
and has recently been experiencing fecal incontinence. the patients symptoms.
However, the nurse has observed no recent change in B) Provide the patient with a bland, low-residue diet.
the character of the patients stools. C) Toilet the patient on a frequent, scheduled basis.
D) Liaise with the primary care provider to obtain an order for
loperamide.

25. An adult patient has been diagnosed with diverticular A) Anticholinergic medications
disease after ongoing challenges with constipation. The B) Increased fiber intake
patient will be treated on an outpatient basis. What C) Enemas on alternating days
components of treatment should the nurse anticipate? D) Reduced fat intake
Select all that apply. E) Fluid reduction

26. A patients health history is suggestive of inflammatory A) A pattern of distinct exacerbations and remissions
bowel disease. Which of the following would suggest B) Severe diarrhea
Crohns disease, rather that ulcerative colitis, as the C) An absence of blood in stool
cause of the patients signs and symptoms? D) Involvement of the rectal mucosa

27. During a patients scheduled home visit, an older adult A) Regular application of an OTC antibiotic ointment
patient has stated to the community health nurse that B) Increased fluid and fiber intake
she has been experiencing hemorrhoids of increasing C) Daily use of OTC glycerin suppositories
severity in recent months. The nurse should D) Use of an NSAID to reduce inflammation
recommend which of the following?

28. A nurse is providing care for a patient whose recent A) Encourage the patient to conduct online research into
colostomy has contributed to a nursing diagnosis of colostomies.
Disturbed Body Image Related to Colostomy. What B) Engage the patient in the care of the ostomy to the
intervention best addresses this diagnosis? extent that the patient is willing.
C) Emphasize the fact that the colostomy was needed to
alleviate a much more serious health
problem.
D) Emphasize the fact that the colostomy is temporary
measure and is not permanent.

29. A nurse is caring for a patient who has been admitted to A) Acute Pain Related to Increased Peristalsis and GI
the hospital with diverticulitis. Which of the following Inflammation
would be appropriate nursing diagnoses for this B) Activity Intolerance Related to Generalized Weakness
patient? Select all that apply. C) Bowel Incontinence Related to Increased Intestinal
Peristalsis
D) Deficient Fluid Volume Related to Anorexia, Nausea,
and Diarrhea
E) Impaired Urinary Elimination Related to GI Pressure on the
Bladder

30. The nurse is providing care for a patient whose A) Anticholinergic medications 30 minutes before a meal
inflammatory bowel disease has necessitated hospital B) Antiemetics on a PRN basis
treatment. Which of the following would most likely be C) Vitamin B12 injections to prevent pernicious anemia
included in the patients medication regimen? D) Beta adrenergic blockers to reduce bowel motility

31. A patients colorectal cancer has necessitated a A) Ensure that the patient knows that he or she will be
hemicolectomy with the creation of a colostomy. In the responsible for care after discharge.
4 days since the surgery, the patient has been unwilling B) Reassure the patient that many people are fearful after the
to look at the ostomy or participate in any aspects of creation of an ostomy.
ostomy care. What is the nurses most appropriate C) Acknowledge the patients reluctance and initiate
response to this observation? discussion of the factors underlying it.
D) Arrange for the patient to be seen by a social worker or
spiritual advisor.

32. A nurse is caring for an older adult who has been A) White blood cell level
experiencing severeClostridium dif icile-related B) Creatinine level
diarrhea. When reviewing the patients most recent C) Hemoglobin level
laboratory tests, the nurse should prioritize which of the D) Potassium level
following?

33. A nurse is assessing a patients stoma on postoperative A) Irrigate the ostomy to clear a possible obstruction.
day 3. The nurse notes that the stoma has a shiny B) Contact the primary care provider to report this finding.
appearance and a bright red color. How should the C) Document that the stoma appears healthy and well
nurse best respond to this assessment finding? perfused.
D) Document a nursing diagnosis of Impaired Skin Integrity.

34. A patient has been diagnosed with a small bowel A) Preventing infection
obstruction and has been admitted to the medical unit. B) Maintaining skin and tissue integrity
C) Preventing nausea and vomiting
D) Maintaining fluid and electrolyte balance

35. A patients large bowel obstruction has failed to resolve A) Administering bowel stimulants as ordered
spontaneously and the patients worsening condition B) Administering bulk-forming laxatives as ordered
has warranted admission to the medical unit. Which of C) Performing deep palpation as ordered to promote
the following aspects of nursing care is most peristalsis
appropriate for this patient? D) Preparing the patient for surgical bowel resection
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36. A patient has been experiencing occasional episodes of A) Mineral oil enemas
constipation and has been unable to achieve consistent B) Bisacodyl (Dulcolax)
relief by increasing physical activity and improving his C) Senna (Senokot)
diet. What pharmacologic intervention should the nurse D) Psyllium hydrophilic mucilloid (Metamucil)
recommend to the patient for ongoing use?

37. A patient with a diagnosis of colon cancer is 2 days A) Close monitoring of temperature
postoperative following bowel resection and B) Frequent abdominal auscultation
anastomosis. The nurse has planned the patients care C) Assessment of hemoglobin, hematocrit, and red blood cell
in the knowledge of potential complications. What levels
assessment should the nurse prioritize? D) Palpation of peripheral pulses and leg girth

38. A teenage patient with a pilonidal cyst has been brought A) Risk for infection
for care by her mother. The nurse who is contributing to B) Risk for bowel incontinence
the patients care knows that treatment will be chosen C) Risk for constipation
based on what risk? D) Risk for impaired tissue perfusion

39. A nurse at an outpatient surgery center is caring for a A) The appropriate use of antibiotics to prevent postoperative
patient who had a hemorrhoidectomy. What discharge infection
education topics should the nurse address with this B) The correct procedure for taking a sitz bath
patient? C) The need to eat a low-residue, low-fat diet for the next 2
weeks
D) The correct technique for keeping the perianal region clean
without the use of water

40. Which of the following is the most plausible nursing A) Risk for Unstable Blood Glucose Due to Changes in
diagnosis for a patient whose treatment for colon Digestion and Absorption
cancer has necessitated a colonostomy? B) Unilateral Neglect Related to Decreased Physical Mobility
C) Risk for Excess Fluid Volume Related to Dietary Changes
and Changes In Absorption
D) Ineffective Sexuality Patterns Related to Changes in
Self-Concept

CHAPTER 7
QUESTION ANSWER

1. A nurse is caring for a patient with liver failure and is A) Alterations in glucose metabolism
performing an assessment in the knowledge of the B) Retention of bile salts
patients increased risk of bleeding. The nurse C) Inadequate production of albumin by hepatocytes
recognizes that this risk is related to the patients D) Inability of the liver to use vitamin K
inability to synthesize prothrombin in the liver. What
factor most likely contributes to this loss of function?

2. A nurse is performing an admission assessment of a A) Place hand under the right lower abdominal quadrant and
patient with a diagnosis of cirrhosis. What technique press down lightly with the other hand.
should the nurse use to palpate the patients liver? 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.

3. A patient with portal hypertension has been admitted to A) Assessment of blood pressure and assessment for
the medical floor. The nurse should prioritize which of headaches and visual changes
the following assessments related to the manifestations B) Assessments for signs and symptoms of venous
of this health problem? thromboembolism
C) Daily weights and abdominal girth measurement
D) Blood glucose monitoring q4h

4. A nurse educator is teaching a group of recent nursing A) Immunization

graduates about their occupational risks for contracting B) Use of standard precautions
hepatitis B. What preventative measures should the C) Consumption of a vitamin-rich diet
educator promote? Select all that apply. D) Annual vitamin K injections
E) Annual vitamin B12 injections

5. A nurse is caring for a patient with cancer of the liver A) Document the presence of normal bile output.
whose condition has required the insertion of a B) Irrigate the drainage system with normal saline as ordered.
percutaneous biliary drainage system. The nurses most C) Aspirate a sample of the drainage for culture.
recent assessment reveals the presence of dark green D) Promptly report this assessment finding to the primary care
fluid in the collection container. What is the nurses best provider.
response to this assessment finding?

6. A patient who has undergone liver transplantation is A) The patient will obtain measurement of drainage from the T-
ready to be discharged home. Which outcome of tube.
health education should the nurse prioritize? 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.
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7. A triage nurse in the emergency department is A) How many alcoholic drinks do you typically consume
assessing a patient who presented with complaints of in a week?
general malaise. Assessment reveals the presence of B) To the best of your knowledge, are your immunizations up
jaundice and increased abdominal girth. What to date?
assessment question best addresses the possible C) Have you ever worked in an occupation where you might
etiology of this patient’s presentation? have been exposed to toxins?
D) Has anyone in your family ever experienced symptoms
similar to yours?

8. A nurse is participating in the emergency care of a A) Infusion of intravenous heparin

patient who has just developed variceal bleeding. What B) IV administration of albumin
intervention should the nurse anticipate? C) STAT administration of vitamin K by the intramuscular route
D) IV administration of octreotide (Sandostatin)

9. A nurse is caring for a patient with hepatic A) Asterixis

encephalopathy. While making the initial shift B) Constructional apraxia
assessment, the nurse notes that the patient has a C) Fetor hepaticus
flapping tremor of the hands. The nurse should D) Palmar erythema
document the presence of what sign of liver disease?

10. A local public health nurse is informed that a cook in a A) The hepatitis A vaccine
local restaurant has been diagnosed with hepatitis A. B) Albumin infusion
What should the nurse advise individuals to obtain who C) The hepatitis A and B vaccines
ate at this restaurant and have never received the D) An immune globulin injection
hepatitis A vaccine?

11. A participant in a health fair has asked the nurse about A) Finish all prescribed courses of antibiotics, regardless of
the role of drugs in liver disease. What health promotion symptom resolution.
teaching has the most potential to prevent drug-induced B) Adhere to dosing recommendations of OTC analgesics.
hepatitis? C) Ensure that expired medications are disposed of safely.
D) Ensure that pharmacists regularly review drug regimens for
potential interactions.

12. Diagnostic testing has revealed that a patients A) Cryosurgery

hepatocellular carcinoma (HCC) is limited to one lobe. B) Liver transplantation
The nurse should anticipate that this patient’s plan of C) Lobectomy
care will focus on what intervention? D) Laser hyperthermia

13. A patient has been diagnosed with advanced stage A) Persistent fever and cognitive changes
breast cancer and will soon begin aggressive treatment. B) Abdominal pain and hepatomegaly
What assessment findings would most strongly suggest C) Peripheral edema unresponsive to diuresis
that the patient may have developed liver metastases? D) Spontaneous bleeding and jaundice

14. A patient is being discharged after a liver transplant and A) Risk for Infection Related to Immunosuppressant Use
the nurse is performing discharge education. When B) Risk for Injury Related to Decreased Hemostasis
planning this patients continuing care, the nurse should C) Risk for Unstable Blood Glucose Related to Impaired
prioritize which of the following risk diagnoses? Gluconeogenesis
D) Risk for Contamination Related to Accumulation of
Ammonia

15. A patient with a liver mass is undergoing a A) Position the patient on the right side with a pillow
percutaneous liver biopsy. What action should the under the costal margin after the procedure.
nurse perform when assisting with this procedure? B) Administer 1 unit of albumin 90 minutes before the
procedure as ordered.
C) Administer at least 1 unit of packed red blood cells as
ordered the day before the scheduled
procedure.
D) Confirm that the patients electrolyte levels have been
assessed prior to the procedure.

16. A nurse is caring for a patient with hepatic A) Stage 1

encephalopathy. The nurses assessment reveals that B) Stage 2
the patient exhibits episodes of confusion, is difficult to C) Stage 3
arouse from sleep and has rigid extremities. Based on D) Stage 4
these clinical findings, the nurse should document what
stage of hepatic encephalopathy?

17. A patient has developed hepatic encephalopathy A) Two to 3 soft bowel movements daily
secondary to cirrhosis and is receiving care on the B) Significant increase in appetite and food intake
medical unit. The patients current medication regimen C) Absence of nausea and vomiting
includes lactulose (Cephulac) D) Absence of blood or mucus in stool

18. A nurse is performing an admission assessment for an A) Similar liver size and texture as in younger adults
81-year-old patient who generally enjoys good health. B) A nonpalpable liver
When considering normal, age-related changes to C) A slightly enlarged liver with palpably hard edges
hepatic function, the nurse should anticipate what D) A slightly decreased size of the liver
finding?
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19. A nurse is caring for a patient with a blocked bile duct A) Watery, blood-streaked diarrhea
from a tumor. What manifestation of obstructive B) Orange and foamy urine
jaundice should the nurse anticipate? C) Increased abdominal girth
D) Decreased cognition

20. During a health education session, a participant has A) Following proper hand-washing techniques
asked about the hepatitis E virus. What prevention B) Avoiding chemicals that are toxic to the liver
measure should the nurse recommend for preventing C) Wearing a condom during sexual contact
infection with this virus? D) Limiting alcohol intake

21. A patients physician has ordered a liver panel in A) Alanine aminotransferase (ALT)
response to the patients development of jaundice. B) C-reactive protein (CRP)
When reviewing the results of this laboratory testing, C) Gamma-glutamyl transferase (GGT)
the nurse should expect to review what blood tests? D) Aspartate aminotransferase (AST)
Select all that apply. E) B-type natriuretic peptide (BNP)

22. A patient with liver disease has developed jaundice; the A) Increased potassium intake
nurse is collaborating with the patient to develop a B) Fluid restriction to 2 L per day
nutritional plan. The nurse should prioritize which of the C) Reduction in sodium intake
following in the patients plan? D) High-protein, low-fat diet

23. A nurse is amending a patients plan of care in light of A) Mobilization with assistance at least 4 times daily
the fact that the patient has recently developed ascites. B) Administration of beta-adrenergic blockers as ordered
What should the nurse include in this patients care C) Vitamin B12 injections as ordered
plan? D) Administration of diuretics as ordered

24. A nurse is caring for a patient who has been admitted A) Measurement of abdominal girth and body weight
for the treatment of advanced cirrhosis. What B) Assessment for variceal bleeding
assessment should the nurse prioritize in this patients C) Assessment for signs and symptoms of jaundice
plan of care? D) Monitoring of results of liver function testing

25. A patient with a diagnosis of cirrhosis has developed A) Decisional Conflict

variceal bleeding and will imminently undergo variceal B) Deficient Knowledge
banding. What psychosocial nursing diagnosis should C) Death Anxiety
the nurse most likely prioritize during this phase of the D) Disturbed Thought Processes
patients treatment?

26. A patient with a diagnosis of esophageal varices has A) Keep patient NPO until the results of test are known.
undergone endoscopy to gauge the progression of this B) Keep patient NPO until the patients gag reflex returns.
complication of liver disease. Following the completion C) Administer analgesia until post-procedure tenderness is
of this diagnostic test, what nursing intervention should relieved.
the nurse perform? D) Give the patient a cold beverage to promote swallowing
ability.

27. A patient with esophageal varices is being cared for in A) Arterial line
the ICU. The varices have begun to bleed and the B) Diuretics
patient is at risk for hypovolemia. The patient has C) Foley catheter
Ringers lactate at 150 cc/hr infusing. What else might D) Volume expanders
the nurse expect to have ordered to maintain volume for
this patient?

28. A patient with a history of injection drug use has been A) Administration of immune globulins
diagnosed with hepatitis C. When collaborating with the B) A regimen of antiviral medications
care team to plan this patients treatment, the nurse C) Rest and watchful waiting
should anticipate what intervention? D) Administration of fresh-frozen plasma (FFP)

29. A group of nurses have attended an in service on the A) Disposing of sharps appropriately and not recapping
prevention of occupationally acquired diseases that needles
affect healthcare providers. What action has the B) Performing meticulous hand hygiene at the appropriate
greatest potential to reduce a nurses risk of acquiring moments in care
hepatitis C in the workplace? C) Adhering to the recommended schedule of immunizations
D) Wearing an N95 mask when providing care for patients on
airborne precautions

30. A patient has been admitted to the critical care unit with A) 1, 2, 5, 4, 3
a diagnosis of toxic hepatitis. When planning the B) 1, 2, 3, 4, 5
patients care, the nurse should be aware of what C) 2, 3, 1, 4, 5
potential clinical course of this health problem? Place D) 3, 1, 2, 5, 4
the following events in the correct sequence.

1. Fever rises. 2. Hematemesis. 3. Clotting

abnormalities. 4. Vascular collapse. 5. Coma.
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31. A previously healthy adults sudden and precipitous A) IV administration of immune globulins
decline in health has been attributed to fulminant B) Transfusion of packed red blood cells and fresh-frozen
hepatic failure, and the patient has been admitted to the plasma (FFP)
intensive care unit. The nurse should be aware that the C) Liver transplantation
treatment of choice for this patient is what? D) Lobectomy

32. A nurse is caring for a patient with cirrhosis secondary A) Ensure that the patients sodium intake does not exceed
to heavy alcohol use. The nurses most recent recommended levels.
assessment reveals subtle changes in the patients B) Report this finding to the primary care provider due to
cognition and behavior. What is the nurses most the possibility of hepatic encephalopathy.
appropriate response? C) Inform the primary care provider that the patient should be
assessed for alcoholic hepatitis.
D) Implement interventions aimed at ensuring a calm and
therapeutic care environment.

33. A patient with end-stage liver disease has developed A) Administering diuretics
hypervolemia. What nursing interventions would be B) Administering calcium channel blockers
most appropriate when addressing the patients fluid C) Implementing fluid restrictions
volume excess? Select all that apply. D) Implementing a 1500 kcal/day restriction
E) Enhancing patient positioning

34. A patient with liver cancer is being discharged home A) Aspirating bile from the catheter using a syringe
with a biliary drainage system in place. The nurse B) Removing the catheter when output is 15 mL in 24 hours
should teach the patients family how to safely perform C) Instilling antibiotics into the catheter
which of the following actions? D) Assessing the patency of the drainage catheter

35. A patient with cirrhosis has experienced a progressive A) By considering the patients age and prognosis
decline in his health; and liver transplantation is being B) By objectively determining the patients medical need
considered by the interdisciplinary team. How will the C) By objectively assessing the patients willingness to adhere
patients prioritization for receiving a donor liver be to post-transplantation care
determined? D) By systematically ruling out alternative treatment options

36. A nurse has entered the room of a patient with cirrhosis A) Remove the patients commode and supply a bedpan.
and found the patient on the floor. The patient states B) Complete an incident report and submit it to the unit
that she fell when transferring to the commode. The supervisor.
patients vital signs are within reference ranges and the C) Have the patient assessed by the physician due to the
nurse observes no apparent injuries. What is the nurses risk of internal bleeding.
most appropriate action? D) Perform a focused abdominal assessment in order to rule
out injury.

37. A patient with liver cancer is being discharged home A) Continuous monitoring for portal hypertension
with a hepatic artery catheter in place. The nurse B) Administration of immunosuppressive drugs during the first
should be aware that this catheter will facilitate which of weeks after transplantation
the following? C) Real-time monitoring of vascular changes in the hepatic
system
D) Delivery of a continuous chemotherapeutic dose

38. A nurse on a solid organ transplant unit is planning the A) Implementation of infection-control measures
care of a patient who will soon be admitted upon B) Close monitoring of skin integrity and color
immediate recovery following liver transplantation. What C) Frequent assessment of the patients psychosocial status
aspect of nursing care is the nurses priority? D) Administration of antiretroviral medications

39. A 55-year-old female patient with hepatocellular A) Destruction of the patients liver tumor
carcinoma (HCC) is undergoing radiofrequency B) Restoration of portal vein patency
ablation. The nurse should recognize what goal of this C) Destruction of a liver abscess
treatment? D) Reversal of metastasis

40. A nurse is caring for a patient with severe hemolytic A) Chronic jaundice
jaundice. Laboratory tests show free bilirubin to be 24 B) Pigment stones in portal circulation
mg/dL. For what complication is this patient at risk? C) Central nervous system damage
D) Hepatomegaly
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CHAPTER 8
QUESTION ANSWER

1. A nurse is assessing a patient who has been diagnosed A) Left upper chest
with cholecystitis, and is experiencing localized B) Inguinal region
abdominal pain. When assessing the characteristics of C) Neck or jaw
the patients pain, the nurse should anticipate that it may D) Right shoulder
radiate to what region?

2. A 55-year-old man has been newly diagnosed with A) Toxins have accumulated and inflamed your pancreas.
acute pancreatitis and admitted to the acute medical B) Bacteria likely migrated from your intestines and became
unit. How should the nurse most likely explain the lodged in your pancreas.
pathophysiology of this patients health problem? C) A virus that was likely already present in your body has
begun to attack your pancreatic cells.
D) The enzymes that your pancreas produces have
damaged the pancreas itself.

3. A patients assessment and diagnostic testing are A) How many alcoholic drinks do you typically consume
suggestive of acute pancreatitis. When the nurse is in a week?
performing the health interview, what assessment B) Have you ever been tested for diabetes?
questions address likely etiologic factors? Select all that C) Have you ever been diagnosed with gallstones?
apply. D) Would you say that you eat a particularly high-fat diet?
E) Does anyone in your family have cystic fibrosis?

4. A patients abdominal ultrasound indicates cholelithiasis. A) Increased bilirubin

When the nurse is reviewing the patients laboratory B) Decreased serum cholesterol
studies, what finding is most closely associated with this C) Increased blood urea nitrogen (BUN)
diagnosis? D) Decreased serum alkaline phosphatase level

5. A nurse who provides care in a walk-in clinic assesses A) A 45-year-old obese woman with a high-fat diet
a wide range of individuals. The nurse should identify B) An 18-year-old man who is a weekend binge drinker
which of the following patients as having the highest C) A 39-year-old man with chronic alcoholism
risk for chronic pancreatitis? D) A 51-year-old woman who smokes one-and-a-half packs of
cigarettes per day

6. A 37-year-old male patient presents at the emergency A) Severe pancreatitis with possible peritonitis
department (ED) complaining of nausea and vomiting B) Acute cholecystitis
and severe abdominal pain. The patients abdomen is C) Chronic pancreatitis
rigid, and there is bruising to the patients flank. The D) Acute appendicitis with possible perforation
patients wife states that he was on a drinking binge for
the past 2 days. The ED nurse should assist in
assessing the patient for what health problem?

7. A patient has been scheduled for an ultrasound of the A) Have the patient refrain from food and fluids after
gallbladder the following morning. What should the midnight.
nurse do in preparation for this diagnostic study? B) Administer the contrast agent orally 10 to 12 hours before
the study.
C) Administer the radioactive agent intravenously the evening
before the study.
D) Encourage the intake of 64 ounces of water 8 hours before
the study.

8. A patient who had surgery for gallbladder disease has A) Decreased breath sounds
just returned to the postsurgical unit from B) Drainage of bile-colored fluid onto the abdominal dressing
postanesthetic recovery. The nurse caring for this C) Rigidity of the abdomen
patient knows to immediately report what assessment D) Acute pain with movement
finding to the physician?

9. A patient with chronic pancreatitis had a A) The majority of patients who have a pancreaticojejunostomy
pancreaticojejunostomy created 3 months ago for relief have their normal digestion restored
of pain and to restore drainage of pancreatic secretions. but do not achieve pain relief.
The patient has come to the office for a routine B) Pain relief occurs by 6 months in most patients who
postsurgical appointment. The patient is frustrated that undergo this procedure, but some people
the pain has not decreased. What is the most experience a recurrence of their pain.
appropriate initial response by the nurse? C) Your physician will likely want to discuss the removal of
your gallbladder to achieve pain relief.
D) You are probably not appropriately taking the medications
for your pancreatitis and pain, so we
will need to discuss your medication regimen in detail.

10. A nurse is caring for a patient who has been scheduled A) The need to protect the incision postprocedure
for endoscopic retrograde cholangiopancreatography B) The use of moderate sedation
(ERCP) the following day. When providing anticipatory C) The need to infuse 50% dextrose during the procedure
guidance for this patient, the nurse should describe D) The use of general anesthesia
what aspect of this diagnostic procedure?

11. A patient has undergone a laparoscopic A) Management of fluid balance in the home setting
cholecystectomy and is being prepared for discharge B) The need for blood glucose monitoring for the next week
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home. When providing health education, the nurse C) Signs and symptoms of intra-abdominal complications
should prioritize which of the following topics? D) Appropriate use of prescribed pancreatic enzymes

12. A nurse is preparing a plan of care for a patient with A) Disturbed Body Image
pancreatic cysts that have necessitated drainage B) Impaired Skin Integrity
through the abdominal wall. What nursing diagnosis C) Nausea
should the nurse prioritize? D) Risk for Deficient Fluid Volume

13. A home health nurse is caring for a patient discharged A) Proteinuria and hyperkalemia
home after pancreatic surgery. The nurse documents B) Hemorrhage and hypercalcemia
the nursing diagnosis Risk for Imbalanced Nutrition: C) Weight loss and hypoglycemia
Less than Body Requirements on the care plan based D) Malabsorption and hyperglycemia
on the potential complications that may occur after
surgery. What are the most likely complications for the
patient who has had pancreatic surgery?

14. A patient has had a laparoscopic cholecystectomy. The A) Aspirin every 4 to 6 hours as ordered
patient is now complaining of right shoulder pain. What B) Application of heat 15 to 20 minutes each hour
should the nurse suggest to relieve the pain? C) Application of an ice pack for no more than 15 minutes
D) Application of liniment rub to affected area

15. A patient returns to the floor after a laparoscopic A) Diabetic coma

cholecystectomy. The nurse should assess the patient B) Decubitus ulcer
for signs and symptoms of what serious potential C) Wound evisceration
complication of this surgery? D) Bile duct injury

16. A patient has been treated in the hospital for an episode A) Educate the patient about the link between alcohol use and
of acute pancreatitis. The patient has acknowledged the pancreatitis.
role that his alcohol use played in the development of B) Ensure that the patient knows the importance of attending
his health problem, but has not expressed specific follow-up appointments.
plans for lifestyle changes after discharge. What is the C) Refer the patient to social work or spiritual care.
nurses most appropriate response? D) Encourage the patient to connect with a community-
based support group.

17. A patient is being treated on the acute medical unit for A) Position the patient supine to facilitate diaphragm
acute pancreatitis. The nurse has identified a diagnosis movement.
of Ineffective Breathing Pattern Related to Pain. What B) Administer corticosteroids by nebulizer as ordered.
intervention should the nurse perform in order to best C) Perform oral suctioning as needed to remove secretions.
address this diagnosis? D) Maintain the patient in a semi-Fowlers position
whenever possible.

18. A patient with gallstones has been prescribed A) It is important that I see my physician for scheduled follow-
ursodeoxycholic acid (UDCA). The nurse understands up appointments while taking this
that additional teaching is needed regarding this medication.
medication when the patient states: B) I will take this medication for 2 weeks and then
gradually stop taking it.
C) If I lose weight, the dose of the medication may need to be
changed.
D) This medication will help dissolve small gallstones made of
cholesterol.

19. A nurse is assisting with serving dinner trays on the A) Fried chicken
unit. Upon receiving the dinner tray for a patient B) Mashed potatoes
admitted with acute gallbladder inflammation, the nurse C) Dinner roll
will question which of the following foods on the tray? D) Tapioca pudding

20. A nurse is assessing an elderly patient with gallstones. A) Fever and pain
The nurse is aware that the patient may not exhibit B) Chills and jaundice
typical symptoms, and that particular symptoms that C) Nausea and vomiting
may be exhibited in the elderly patient may include D) Signs and symptoms of septic shock
what?

21. A nurse is creating a care plan for a patient with acute A) Bed rest reduces the patients metabolism and reduces the
pancreatitis. The care plan includes reduced activity. risk of metabolic acidosis.
What rationale for this intervention should be cited in B) Reduced activity protects the physical integrity of pancreatic
the care plan? cells.
C) Bed rest lowers the metabolic rate and reduces enzyme
production.
D) Inactivity reduces caloric need and gastrointestinal motility.

22. The nurse is caring for a patient who has just returned A) Pain and peritonitis
from the ERCP removal of gallstones. The nurse should B) Bleeding and perforation
monitor the patient for signs of what complications? C) Acidosis and hypoglycemia
D) Gangrene of the gallbladder and hyperglycemia

23. A patient with pancreatic cancer has been scheduled A) Gallbladder

for a pancreaticoduodenectomy (Whipple procedure). B) Part of the stomach
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During health education, the patient should be informed C) Duodenum
that this procedure will involve the removal of which of D) Part of the common bile duct
the following? Select all that apply. E) Part of the rectum

24. An adult patient has been admitted to the medical unit A) Measure the patients abdominal girth daily.
for the treatment of acute pancreatitis. What nursing B) Limit the use of opioid analgesics.
action should be included in this patients plan of care? C) Monitor the patient for signs of dysphagia.
D) Encourage activity as tolerated.

25. A community health nurse is caring for a patient whose A) Administer a PRN dose of pancreatic enzymes as ordered.
multiple health problems include chronic pancreatitis. B) Teach the patient about the importance of abstaining from
During the most recent visit, the nurse notes that the alcohol.
patient is experiencing severe abdominal pain and has C) Arrange for the patient to be transported to the
vomited 3 times in the past several hours. What is the hospital.
nurses most appropriate action? D) Insert an NG tube, if available, and stay with the patient.

26. A student nurse is caring for a patient who has a A) Fluid output
diagnosis of acute pancreatitis and who is receiving B) Oral intake
parenteral nutrition. The student should prioritize which C) Blood glucose levels
of the following assessments? D) BUN and creatinine levels
.

27. A patient has a recent diagnosis of chronic pancreatitis A) Glucose tolerance test
and is undergoing diagnostic testing to determine B) ERCP
pancreatic islet cell function. The nurse should C) Pancreatic biopsy
anticipate what diagnostic test? D) Abdominal ultrasonography

28. A patient has been admitted to the hospital for the A) Educating the patient about expectations and care following
treatment of chronic pancreatitis. The patient has been surgery
stabilized and the nurse is now planning health B) Educating the patient about the management of blood
promotion and educational interventions. Which of the glucose after discharge
following should the nurse prioritize? C) Educating the patient about postdischarge lifestyle
modifications
D) Educating the patient about the potential benefits of
pancreatic transplantation

29. The family of a patient in the ICU diagnosed with acute A) Air beds allow the care team to reposition her more easily
pancreatitis asks the nurse why the patient has been while shes on bed rest.
moved to an air bed. What would be the nurses best B) Air beds are far more comfortable than regular beds and
response? shell likely have to be on bed rest a long
C) The bed automatically moves, so she’s less likely to
develop pressure sores while she’s in bed.
D) The bed automatically moves, so she is likely to have less
pain.

30. A patient is receiving care in the intensive care unit for A) Sudden increase in random blood glucose readings
acute pancreatitis. The nurse is aware that pancreatic B) Increased abdominal girth accompanied by decreased level
necrosis is a major cause of morbidity and mortality in of consciousness
patients with acute pancreatitis. C) Fever, increased heart rate and decreased blood
pressure
D) Abdominal pain unresponsive to analgesics

31. A patient has been diagnosed with acute pancreatitis. A) Oral oxycodone
The nurse is addressing the diagnosis of Acute Pain B) IV hydromorphone (Dilaudid)
Related to Pancreatitis. What pharmacologic C) IM meperidine (Demerol)
intervention is most likely to be ordered for this patient? D) Oral naproxen (Aleve)

32. A patient has just been diagnosed with chronic A) The symptoms of pancreatitis mimic those of much less
pancreatitis. The patient is underweight and in severe serious illnesses.
pain and diagnostic testing indicates that over 80% of B) Your body doesnt require pancreatic function until it is
the patients pancreas has been destroyed. The patient under great stress, so it is easy to go
asks the nurse why the diagnosis was not made earlier unnoticed.
in the disease process. What would be the nurses best C) Chronic pancreatitis often goes undetected until a large
response? majority of pancreatic function is lost.
D) Its likely that your other organs were compensating for your
decreased pancreatic function.

33. A patient has been diagnosed with pancreatic cancer A) Inpatient rehabilitation
and has been admitted for care. Following initial B) Rehabilitation in the home setting
treatment, the nurse should be aware that the patient is C) Intensive physical therapy
most likely to require which of the following? D) Hospice care

34. A patient is admitted to the ICU with acute pancreatitis. A) Type 1 diabetes
The patients family asks what causes acute B) An impaired immune system
pancreatitis. The critical care nurse knows that a C) Undiagnosed chronic pancreatitis
majority of patients with acute pancreatitis have what? D) An amylase deficiency

35. A patient is admitted to the unit with acute cholecystitis. A) Surgery is delayed until the patient can eat a regular diet
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The physician has noted that surgery will be scheduled without vomiting.
in 4 days. The patient asks why the surgery is being put B) Surgery is delayed until the acute symptoms subside.
off for a week when he has a sick gallbladder. What C) The patient requires aggressive nutritional support prior to
rationale would underlie the nurses response? surgery.
D) Time is needed to determine whether a laparoscopic
procedure can be used.

36. A patient with a cholelithiasis has been scheduled for a A) Laparoscopic cholecystectomy poses fewer surgical
laparoscopic cholecystectomy. Why is laparoscopic risks than an open procedure.
cholecystectomy preferred by surgeons over an open B) Laparoscopic cholecystectomy can be performed in a clinic
procedure? setting, while an open procedure
requires an OR.
C) A laparoscopic approach allows for the removal of the
entire gallbladder.
D) A laparoscopic approach can be performed under
conscious sedation.

37. A patient with ongoing back pain, nausea, and A) Laparoscopic cholecystectomy
abdominal bloating has been diagnosed with B) Methyl tertiary butyl ether (MTBE) infusion
cholecystitis secondary to gallstones. The nurse should C) Intracorporeal lithotripsy
anticipate that the patient will undergo what D) Extracorporeal shock wave therapy (ESWL)
intervention?

38. A nurse is caring for a patient with gallstones who has A) It inhibits the synthesis of bile.
been prescribed ursodeoxycholic acid (UDCA). The B) It inhibits the synthesis and secretion of cholesterol.
patient asks how this medicine is going to help his C) It inhibits the secretion of bile.
symptoms. The nurse should be aware of what aspect D) It inhibits the synthesis and secretion of amylase.
of this drugs pharmacodynamics?

39. A nurse is providing discharge education to a patient A) High-fiber foods

who has undergone a laparoscopic cholecystectomy. B) Low-purine, nutrient-dense foods
During the immediate recovery period, the nurse should C) Low-fat foods high in proteins and carbohydrates
recommend what foods? D) Foods that are low-residue and low in fat

40. A patient presents to the emergency department (ED) A) Acute pancreatitis

complaining of severe right upper quadrant pain. The B) Atrophy of the gallbladder
patient states that his family doctor told him he had C) Gallbladder cancer
gallstones. The ED nurse should recognize what D) Gangrene of the gallbladder
possible complication of gallstones?

CHAPTER 9

QUESTION ANSWER

1. A patient with type 1 diabetes has told the nurse that his A) The patient should withhold his next scheduled dose of
most recent urine test for ketones was positive. What is insulin.
the nurses most plausible conclusion based on this B) The patient should promptly eat some protein and
assessment finding? carbohydrates.
C) The patients insulin levels are inadequate.
D) The patient would benefit from a dose of metformin
(Glucophage).

2. A patient presents to the clinic complaining of A) Fasting plasma glucose greater than or equal to 126
symptoms that suggest diabetes. What criteria would mg/dL
support checking blood levels for the diagnosis of B) Random plasma glucose greater than 150 mg/dL
diabetes? C) Fasting plasma glucose greater than 116 mg/dL on 2
separate occasions
D) Random plasma glucose greater than 126 mg/dL

3. A patient newly diagnosed with type 2 diabetes is A) Low fat generally indicates low sugar.
attending a nutrition class. What general guideline B) Protein should constitute 30% to 40% of caloric intake.
would be important to teach the patients at this class? C) Most calories should be derived from carbohydrates.
D) Animal fats should be eliminated from the diet.

4. A nurse is providing health education to an adolescent A) Adequate sleep

newly diagnosed with type 1 diabetes mellitus and her B) Low stimulation
family. The nurse teaches the patient and family that C) Exercise
which of the following nonpharmacologic measures will D) Low-fat diet
decrease the bodys need for insulin?

5. A medical nurse is caring for a patient with type 1 A) 10:45

diabetes. The patients medication administration record B) 11:15
includes the administration of regular insulin three times C) 11:45
daily. Knowing that the patients lunch tray will arrive at D) 11:50
11:45, when should the nurse administer the patients
insulin?
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6. A patient has just been diagnosed with type 2 diabetes. A) A sulfonylurea
The physician has prescribed an oral antidiabetic agent B) A biguanide
that will inhibit the production of glucose by the liver and C) A thiazolidinedione
thereby aid in the control of blood glucose. What type of D) An alpha glucosidase inhibitor
oral antidiabetic agent did the physician prescribe for
this patient?

7. A diabetes nurse educator is teaching a group of A) Do not eliminate insulin when nauseated and vomiting.
patients with type 1 diabetes about sick day rules. What B) Report elevated glucose levels greater than 150 mg/dL.
guideline applies to periods of illness in a diabetic C) Eat three substantial meals a day, if possible.
patient? D) Reduce food intake and insulin doses in times of illness.

8. The nurse is discussing macrovascular complications of A) The need for frequent eye examinations for patients with
diabetes with a patient. The nurse would address what diabetes
topic during this dialogue? B) The fact that patients with diabetes have an elevated
risk of myocardial infarction
C) The relationship between kidney function and blood glucose
levels
D) The need to monitor urine for the presence of albumin

9. A school nurse is teaching a group of high school A) Have blood glucose levels checked annually.
students about risk factors for diabetes. Which of the B) Stop using tobacco in any form.
following actions has the greatest potential to reduce an C) Undergo eye examinations regularly.
individuals risk for developing diabetes? D) Lose weight, if obese.

10. A 15-year-old child is brought to the emergency A) Type 1 diabetes

department with symptoms of hyperglycemia and is B) Type 2 diabetes
subsequently diagnosed with diabetes. Based on the C) Noninsulin-dependent diabetes
fact that the childs pancreatic beta cells are being D) Prediabetes
destroyed, the patient would be diagnosed with what
type of diabetes?

11. A newly admitted patient with type 1 diabetes asks the A) The tissues in your body are resistant to the action of
nurse what caused her diabetes. When the nurse is insulin, making the glucose levels in your
explaining to the patient the etiology of type 1 diabetes, blood increase.
what process should the nurse describe? B) Damage to your pancreas causes an increase in the
amount of glucose that it releases, and there is
not enough insulin to control it.
C) The amount of glucose that your body makes overwhelms
your pancreas and decreases your
production of insulin.
D) Destruction of special cells in the pancreas causes a
decrease in insulin production. Glucose levels
rise because insulin normally breaks it down.

12. An occupational health nurse is screening a group of A) I’ve always been a fan of sweet foods, but lately Im turned
workers for diabetes. What statement should the nurse off by them.
interpret as suggestive of diabetes? B) Lately, I drink and drink and cant seem to quench my
thirst.
C) No matter how much sleep I get, it seems to take me hours
to wake up.
D) When I went to the washroom the last few days, my urine
smelled odd.

13. A diabetes educator is teaching a patient about type 2 A) I read that a pancreas transplant will provide a cure for my
diabetes. The educator recognizes that the patient diabetes.
understands the primary treatment for type 2 diabetes B) I will take my oral antidiabetic agents when my morning
when the patient states what? blood sugar is high.
C) I will make sure to follow the weight loss plan designed
by the dietitian.
D) I will make sure I call the diabetes educator when I have
questions about my insulin.

14. A diabetes nurse educator is presenting the American A) 10% of calories from carbohydrates, 50% from fat, and the
Diabetes Association (ADA) recommendations for remaining 40% from protein
levels of caloric intake. What do the ADAs B) 10% to 20% of calories from carbohydrates, 20% to 30%
recommendations include? from fat, and the remaining 50% to 60%
from protein
C) 20% to 30% of calories from carbohydrates, 50% to 60%
from fat, and the remaining 10% to 20%
from protein
D) 50% to 60% of calories from carbohydrates, 20% to 30%
from fat, and the remaining 10% to 20%
from protein

15. An older adult patient with type 2 diabetes is brought to A) Administration of antihypertensive medications
 TEST BANK
the emergency department by his daughter. The patient B) Administering sodium bicarbonate intravenously
is found to have a blood glucose level of 623 mg/dL. C) Reversing acidosis by administering insulin
The patients daughter reports that the patient recently D) Fluid and electrolyte replacement
had a gastrointestinal virus and has been confused for
the last 3 hours. The diagnosis of hyperglycemic
hyperosmolar syndrome (HHS) is made. What nursing
action would be a priority?

16. A nurse is caring for a patient with type 1 diabetes who A) Ask the patient to describe the process in detail.
is being discharged home tomorrow. What is the best B) Observe the patient drawing up and administering the
way to assess the patients ability to prepare and self- insulin.
administer insulin? C) Provide a health education session reviewing the main
points of insulin delivery.
D) Review the patients first hemoglobin A1C result after
discharge.

17. An elderly patient comes to the clinic with her daughter. A) An elderly patient with foot ulcers experiences severe foot
The patient is a diabetic and is concerned about foot pain due to the diabetic polyneuropathy.
care. The nurse goes over foot care with the patient and B) Avoiding foot ulcers may mean the difference between
her daughter as the nurse realizes that foot care is institutionalization and continued
extremely important. Why would the nurse feel that foot independent living.
care is so important to this patient? C) Hypoglycemia is linked with a risk for falls; this risk is
elevated in older adults with diabetes.
D) Oral antihyperglycemics have the possible adverse effect of
decreased circulation to the lower extremities

18. A diabetic educator is discussing sick day rules with a A) I will not take my insulin on the days when I am sick,
newly diagnosed type 1 diabetic. The educator is aware but I will certainly check my blood sugar
that the patient will require further teaching when the every 2 hours.
patient states what? B) If I cannot eat a meal, I will eat a soft food such as soup,
gelatin, or pudding six to eight times a
day.
C) I will call the doctor if I am not able to keep liquids in my
body due to vomiting or diarrhea.
D) I will call the doctor if my blood sugar is over 300 mg/dL or if
I have ketones in my urine.

19. Which of the following patients with type 1 diabetes is A) A patient who skips breakfast when his glucose reading is
most likely to experience adequate glucose control? greater than 220 mg/dL
B) A patient who never deviates from her prescribed dose of
insulin
C) A patient who adheres closely to a meal plan and meal
schedule
D) A patient who eliminates carbohydrates from his daily
intake

20. A 28-year-old pregnant woman is spilling sugar in her A) Increased caloric intake during the first trimester
urine. The physician orders a glucose tolerance test, B) Changes in osmolality and fluid balance
which reveals gestational diabetes. The patient is C) The effects of hormonal changes during pregnancy
shocked by the diagnosis, stating that she is D) Overconsumption of carbohydrates during the first two
conscientious about her health, and asks the nurse trimesters
what causes gestational diabetes. The nurse should
explain that gestational diabetes is a result of what
etiologic factor?

21. A medical nurse is aware of the need to screen specific A) Patients who are obese and who have no known history of
patients for their risk of hyperglycemic hyperosmolar diabetes
syndrome (HHS). In what patient population does B) Patients with type 1 diabetes and poor dietary control
hyperosmolar nonketotic syndrome most often occur? C) Adolescents with type 2 diabetes and sporadic use of
antihyperglycemics
D) Middle-aged or older people with either type 2 diabetes
or no known history of diabetes

22. A nurse is caring for a patient newly diagnosed with A) Avoid using the same injection site more than once in 2
type 1 diabetes. The nurse is educating the patient to 3 weeks.
about self-administration of insulin in the home setting. B) Avoid mixing more than one type of insulin in a syringe.
The nurse should teach the patient to do which of the C) Cleanse the injection site thoroughly with alcohol prior to
following? injecting.
D) Inject at a 45 angle.

23. A patient with type 2 diabetes achieves adequate A) Alterations in bile metabolism and release have likely
glycemic control through diet and exercise. Upon being caused hyperglycemia.
admitted to the hospital for a cholecystectomy, B) Stress has likely caused an increase in the patients
however, the patient has required insulin injections on blood sugar levels.
two occasions. The nurse would identify what likely C) The patient has likely overestimated her ability to control
cause for this short-term change in treatment? her diabetes using nonpharmacologic
measures.
D) The patients volatile fluid balance surrounding surgery has
 TEST BANK
likely caused unstable blood sugars.

24. A physician has explained to a patient that he has A) Research has shown that diabetic neuropathy is caused by
developed diabetic neuropathy in his right foot. Later fluctuations in blood sugar that have
that day, the patient asks the nurse what causes gone on for years.
diabetic neuropathy. What would be the nurses best B) The cause is not known for sure but it is thought to have
response? something to do with ketoacidosis.
C) The cause is not known for sure but it is thought to
involve elevated blood glucose levels over a
period of years.
D) Research has shown that diabetic neuropathy is caused by
a combination of elevated glucose levels
and elevated ketone levels.

25. A patient with type 2 diabetes has been managing his A) Monitoring the patients neutrophil levels
blood glucose levels using diet and metformin B) Assessing the patient for signs of impaired liver function
(Glucophage). Following an ordered increase in the C) Monitoring the patients level of consciousness and behavior
patients daily dose of metformin, the nurse should D) Reviewing the patients creatinine and BUN levels
prioritize which of the following assessments?

26. A patient with a longstanding diagnosis of type 1 A) Infection

diabetes has a history of poor glycemic control. The B) Acute pain
nurse recognizes the need to assess the patient for C) Acute confusion
signs and symptoms of peripheral neuropathy. D) Impaired urinary elimination
Peripheral neuropathy constitutes a risk for what
nursing diagnosis?

27. A patient has been brought to the emergency A) IV administration of 50% dextrose in water
department by paramedics after being found B) Subcutaneous administration of 10 units of Humalog
unconscious. The patients Medic Alert bracelet C) Subcutaneous administration of 12 to 15 units of regular
indicates that the patient has type 1 diabetes and the insulin
patients blood glucose is 22 mg/dL (1.2 mmol/L). The D) IV bolus of 5% dextrose in 0.45% NaCl
nurse should anticipate what intervention?

28. A diabetic nurse is working for the summer at a camp A) Always carry a form of fast-acting sugar.
for adolescents with diabetes. When providing B) Perform exercise prior to eating whenever possible.
information on the prevention and management of C) Eat a meal or snack every 8 hours.
hypoglycemia, what action should the nurse promote? D) Check blood sugar at least every 24 hours.

29. A nurse is teaching basic survival skills to a patient A) Signs and symptoms of diabetic nephropathy
newly diagnosed with type 1 diabetes. What topic B) Management of diabetic ketoacidosis
should the nurse address? C) Effects of surgery and pregnancy on blood sugar levels
D) Recognition of hypoglycemia and hyperglycemia

30. A nurse is conducting a class on how to self-manage A) If you are going to use up the vial within 1 month it can
insulin regimens. A patient asks how long a vial of be kept at room temperature.
insulin can be stored at room temperature before it B) If a vial of insulin will be used up within 21 days, it may be
goes bad. What would be the nurses best answer? kept at room temperature.
C) If a vial of insulin will be used up within 2 weeks, it may be
kept at room temperature.
D) If a vial of insulin will be used up within 1 week, it may be
kept at room temperature.

31. A patient has received a diagnosis of type 2 diabetes. A) Ensure that the patient understands the basic
The diabetes nurse has made contact with the patient pathophysiology of diabetes.
and will implement a program of health education. What B) Identify the patients body mass index.
is the nurses priority action? C) Teach the patient survival skills for diabetes.
D) Assess the patients readiness to learn.

32. A student with diabetes tells the school nurse that he is A) A combination of protein and carbohydrates, such as a
feeling nervous and hungry. The nurse assesses the small cup of yogurt
child and finds he has tachycardia and is diaphoretic B) Two teaspoons of sugar dissolved in a cup of apple juice
with a blood glucose level of 50 mg/dL (2.8 mmol/L). C) Half of a cup of juice, followed by cheese and crackers
What should the school nurse administer? D) Half a sandwich with a protein-based filling

33. A patient with a history of type 1 diabetes has just been A) Monitoring the patient for dysrhythmias
admitted to the critical care unit (CCU) for diabetic B) Maintaining and monitoring the patients fluid balance
ketoacidosis. The CCU nurse should prioritize what C) Assessing the patients level of consciousness
assessment during the patients initial phase of D) Assessing the patient for signs and symptoms of venous
treatment? thromboembolism

34. A patient has been living with type 2 diabetes for A) Participation in a support group for persons with
several years, and the nurse realizes that the patient is diabetes
likely to have minimal contact with the health care B) Regular consultation of websites that address diabetes
system. In order to ensure that the patient maintains management
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adequate blood sugar control over the long term, the C) Weekly telephone check-ins with an endocrinologist
nurse should recommend which of the following? D) Participation in clinical trials relating to antihyperglycemics

35. A patient with type 1 diabetes mellitus is seeing the A) Examine feet weekly for redness, blisters, and abrasions.
nurse to review foot care. What would be a priority B) Avoid the use of moisturizing lotions.
instruction for the nurse to give the patient? C) Avoid hot-water bottles and heating pads.
D) Dry feet vigorously after each bath.

36. A diabetes nurse is assessing a patients knowledge of A) Ask the patient to describe an optimally healthy meal.
self-care skills. What would be the most appropriate B) Ask the patient to keep a food diary and review it with
way for the educator to assess the patients knowledge the nurse.
of nutritional therapy in diabetes? C) Ask the patients family what he typically eats.
D) Ask the patient to describe a typical days food intake.

37. The most recent blood work of a patient with a A) Teach the patient about actions to slow the
longstanding diagnosis of type 1 diabetes has shown progression of nephropathy.
the presence of microalbuminuria. What is the nurses B) Ensure that the patient receives a comprehensive
most appropriate action? assessment of liver function.
C) Determine whether the patient has been using expired
insulin.
D) Administer a fluid challenge and have the test repeated.

38. A nurse is assessing a patient who has diabetes for the A) Persistently cold feet
presence of peripheral neuropathy. The nurse should B) Pain that does not respond to analgesia
question the patient about what sign or symptom that C) Acute pain, unrelieved by rest
would suggest the possible development of peripheral D) The presence of a tingling sensation
neuropathy?

39. A diabetic patient calls the clinic complaining of having A) Make sure to stick to your normal diet.
a flu bug. The nurse tells him to take his regular dose of B) Try to eat small amounts of carbs, if possible.
insulin. What else should the nurse tell the patient? C) Ensure that you check your blood glucose every hour.
D) For now, check your urine for ketones every 8 hours.

40. A patient is brought to the emergency department by A) Leukocytosis

the paramedics. The patient is a type 2 diabetic and is B) Glycosuria
experiencing HHS. The nurse should identify what C) Dehydration
components of HHS? Select all that apply. D) Hypernatremia
E) Hyperglycemia