Test Bank Hepatic

Test
Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 922
Chapter 49: Assessment and Management of Patients with Hepatic

Disorders

1. A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the
patients increased risk of bleeding. The nurse recognizes that this risk is related to the patients inability
to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?
A) Alterations in glucose metabolism
B) Retention of bile salts
C) Inadequate production of albumin by hepatocytes
D) Inability of the liver to use vitamin K
Ans: D
Feedback:
Decreased production of several clotting factors may be partially due to deficient absorption of vitamin
K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K to make
prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or albumin.
2. A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What

technique should the nurse use to palpate the patients liver?
A) Place hand under the right lower abdominal quadrant and press down lightly with the other hand.
B) Place the left hand over the abdomen and behind the left side at the 11th rib.
C) Place hand under right lower rib cage and press down lightly with the other hand.
D) Hold hand 90 degrees to right side of the abdomen and push down firmly.
Ans: C
Feedback:
To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward
with light pressure with the other hand. The liver is not on the left side or in the right lower abdominal
quadrant.
3. A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 923
which of the following assessments related to the manifestations of this health problem?
A) Assessment of blood pressure and assessment for headaches and visual changes
B) Assessments for signs and symptoms of venous thromboembolism
C) Daily weights and abdominal girth measurement
D) Blood glucose monitoring q4h
Ans: C
Feedback:
Obstruction to blood flow through the damaged liver results in increased blood pressure (portal
hypertension) throughout the portal venous system. This can result in varices and ascites in the
abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal
hypertension is not synonymous with cardiovascular hypertension and does not create a risk for unstable
blood glucose or VTE.
4. A nurse educator is teaching a group of recent nursing graduates about their occupational risks for
contracting hepatitis B. What preventative measures should the educator promote? Select all that apply.
A) Immunization
B) Use of standard precautions
C) Consumption of a vitamin-rich diet
D) Annual vitamin K injections
E) Annual vitamin B12 injections
Ans: A, B
Feedback:
People who are at high risk, including nurses and other health care personnel exposed to blood or blood
products, should receive active immunization. The consistent use of standard precautions is also highly
beneficial. Vitamin supplementation is unrelated to an individuals risk of HBV.
5. A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a
percutaneous biliary drainage system. The nurses most recent assessment reveals the presence of dark
green fluid in the collection container. What is the nurses best response to this assessment finding?
A) Document the presence of normal bile output.
B) Irrigate the drainage system with normal saline as ordered.
C) Aspirate a sample of the drainage for culture.
D) Promptly report this assessment finding to the primary care provider.
Ans: A
Feedback:
Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment
finding, with no other action necessary.
6. A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of
health education should the nurse prioritize?
A) The patient will obtain measurement of drainage from the T-tube.
B) The patient will exercise three times a week.
C) The patient will take immunosuppressive agents as required.
D) The patient will monitor for signs of liver dysfunction.
Ans: C
Feedback:
The patient is given written and verbal instructions about immunosuppressive agent doses and dosing
schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of
medication is available so that there is no chance of running out of the medication or skipping a dose.
Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient
to measure drainage from a T-tube as the patient wouldnt go home with a T-tube. The nurse may teach
the patient about the need to exercise or what the signs of liver dysfunction are, but the nurse would not
stress these topics over the immunosuppressive drug regimen.
7. A triage nurse in the emergency department is assessing a patient who presented with complaints of
general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What
assessment question best addresses the possible etiology of this patients presentation?
A) How many alcoholic drinks do you typically consume in a week?
B) To the best of your knowledge, are your immunizations up to date?
C) Have you ever worked in an occupation where you might have been exposed to toxins?
D) Has anyone in your family ever experienced symptoms similar to yours?
Ans: A
Feedback:
Signs or symptoms of hepatic dysfunction indicate a need to assess for alcohol use. Immunization status,
occupational risks, and family history are also relevant considerations, but alcohol use is a more
common etiologic factor in liver disease.
8. A nurse is participating in the emergency care of a patient who has just developed variceal bleeding.
What intervention should the nurse anticipate?
A) Infusion of intravenous heparin
B) IV administration of albumin
C) STAT administration of vitamin K by the intramuscular route
D) IV administration of octreotide (Sandostatin)
Ans: D
Feedback:
Octreotide (Sandostatin)a synthetic analog of the hormone somatostatinis effective in decreasing

bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin. Because of this
safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate
control of variceal bleeding. Vitamin K and albumin are not administered and heparin would exacerbate,
not alleviate, bleeding.
9. A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment,
the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the
presence of what sign of liver disease?
A) Asterixis
B) Constructional apraxia
C) Fetor hepaticus
D) Palmar erythema
Ans: A
Feedback:
The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating
asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple
figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath and not associated with a motor
disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a
reddening of the palms, but is not a flapping tremor.
10. A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis
A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received
the hepatitis A vaccine?
A) The hepatitis A vaccine
B) Albumin infusion
C) The hepatitis A and B vaccines
D) An immune globulin injection
Ans: D
Feedback:
For people who have not been previously vaccinated, hepatitis A can be prevented by the intramuscular
administration of immune globulin during the incubation period, if given within 2 weeks of exposure.
Administration of the hepatitis A vaccine will not protect the patient exposed to hepatitis A, as
protection will take a few weeks to develop after the first dose of the vaccine. The hepatitis B vaccine
provides protection again the hepatitis B virus, but plays no role in protection for the patient exposed to
hepatitis A. Albumin confers no therapeutic benefit.
11. A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health
promotion teaching has the most potential to prevent drug-induced hepatitis?
A) Finish all prescribed courses of antibiotics, regardless of symptom resolution.
B) Adhere to dosing recommendations of OTC analgesics.
C) Ensure that expired medications are disposed of safely.
D) Ensure that pharmacists regularly review drug regimens for potential interactions.
Ans: B
Feedback:
Although any medication can affect liver function, use of acetaminophen (found in many over-the-
counter medications used to treat fever and pain) has been identified as the leading cause of acute liver
failure. Finishing prescribed antibiotics and avoiding expired medications are unrelated to this disease.
Drug interactions are rarely the cause of drug-induced hepatitis.
12. Diagnostic testing has revealed that a patients hepatocellular carcinoma (HCC) is limited to one lobe.
The nurse should anticipate that this patients plan of care will focus on what intervention?
A) Cryosurgery
B) Liver transplantation
C) Lobectomy
D) Laser hyperthermia
Ans: C
Feedback:
Surgical resection is the treatment of choice when HCC is confined to one lobe of the liver and the
function of the remaining liver is considered adequate for postoperative recovery. Removal of a lobe of
the liver (lobectomy) is the most common surgical procedure for excising a liver tumor. While
cryosurgery and liver transplantation are other surgical options for management of liver cancer, these
procedures are not performed at the same frequency as a lobectomy. Laser hyperthermia is a nonsurgical
treatment for liver cancer.
13. A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive
treatment. What assessment findings would most strongly suggest that the patient may have developed
liver metastases?
A) Persistent fever and cognitive changes
B) Abdominal pain and hepatomegaly
C) Peripheral edema unresponsive to diuresis
D) Spontaneous bleeding and jaundice
Ans: B
Feedback:
The early manifestations of malignancy of the liver include paina continuous dull ache in the right upper
quadrant, epigastrium, or back. Weight loss, loss of strength, anorexia, and anemia may also occur. The
liver may be enlarged and irregular on palpation. Jaundice is present only if the larger bile ducts are
occluded by the pressure of malignant nodules in the hilum of the liver. Fever, cognitive changes,
peripheral edema, and bleeding are atypical signs.
14. A patient is being discharged after a liver transplant and the nurse is performing discharge education.
When planning this patients continuing care, the nurse should prioritize which of the following risk
diagnoses?
A) Risk for Infection Related to Immunosuppressant Use
B) Risk for Injury Related to Decreased Hemostasis
C) Risk for Unstable Blood Glucose Related to Impaired Gluconeogenesis
D) Risk for Contamination Related to Accumulation of Ammonia
Ans: A
Feedback:
Infection is the leading cause of death after liver transplantation. Pulmonary and fungal infections are
common; susceptibility to infection is increased by the immunosuppressive therapy that is needed to
prevent rejection. This risk exceeds the threats of injury and unstable blood glucose. The diagnosis of
Risk for Contamination relates to environmental toxin exposure.
15. A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse
perform when assisting with this procedure?
A) Position the patient on the right side with a pillow under the costal margin after the 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.
Ans: A
Feedback:
Immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a
pillow under the costal margin. Prior administration of albumin or PRBCs is unnecessary. Coagulation
tests should be performed, but electrolyte analysis is not necessary.
16. A nurse is caring for a patient with hepatic encephalopathy. The nurses assessment reveals that the
patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based
on these clinical findings, the nurse should document what stage of hepatic encephalopathy?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Ans: C
Feedback:
Patients in the third stage of hepatic encephalopathy exhibit the following symptoms: stuporous, difficult
to arouse, sleeps most of the time, exhibits marked confusion, incoherent in speech, asterixis, increased
deep tendon reflexes, rigidity of extremities, marked EEG abnormalities. Patients in stages 1 and 2
exhibit clinical symptoms that are not as advanced as found in stage 3, and patients in stage 4 are
comatose. In stage 4, there is an absence of asterixis, absence of deep tendon reflexes, flaccidity of
extremities, and EEG abnormalities.
17. A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the
medical unit. The patients current medication regimen includes lactulose (Cephulac) four times daily.
What desired outcome should the nurse relate to this pharmacologic intervention?
A) Two to 3 soft bowel movements daily
B) Significant increase in appetite and food intake
C) Absence of nausea and vomiting
D) Absence of blood or mucus in stool
Ans: A
Feedback:
Lactulose (Cephulac) is administered to reduce serum ammonia levels. Two or three soft stools per day
are desirable; this indicates that lactulose is performing as intended. Lactulose does not address the
patients appetite, symptoms of nausea and vomiting, or the development of blood and mucus in the
stool.
18. A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good
health. When considering normal, age-related changes to hepatic function, the nurse should anticipate
what finding?
A) Similar liver size and texture as in younger adults
B) A nonpalpable liver
C) A slightly enlarged liver with palpably hard edges
D) A slightly decreased size of the liver
Ans: D
Feedback:
The most common age-related change in the liver is a decrease in size and weight. The liver is usually
still palpable, however, and is not expected to have hardened edges.
19. A nurse is caring for a patient with a blocked bile duct from a tumor. What manifestation of obstructive
jaundice should the nurse anticipate?
A) Watery, blood-streaked diarrhea
B) Orange and foamy urine
C) Increased abdominal girth
D) Decreased cognition
Ans: B
Feedback:
If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire
body. It is excreted in the urine, which becomes deep orange and foamy. Bloody diarrhea, ascites, and
cognitive changes are not associated with obstructive jaundice.
20. During a health education session, a participant has asked about the hepatitis E virus. What prevention
measure should the nurse recommend for preventing infection with this virus?
A) Following proper hand-washing techniques
B) Avoiding chemicals that are toxic to the liver
C) Wearing a condom during sexual contact
D) Limiting alcohol intake

Ans: A
Feedback:
Avoiding contact with the hepatitis E virus through good hygiene, including hand-washing, is the major
method of prevention. Hepatitis E is transmitted by the fecaloral route, principally through contaminated
water in areas with poor sanitation. Consequently, none of the other listed preventative measures is
indicated.
21. A patients physician has ordered a liver panel in response to the patients development of jaundice. When
reviewing the results of this laboratory testing, the nurse should expect to review what blood tests?
Select all that apply.
A) Alanine aminotransferase (ALT)
B) C-reactive protein (CRP)
C) Gamma-glutamyl transferase (GGT)
D) Aspartate aminotransferase (AST)
E) B-type natriuretic peptide (BNP)
Ans: A, C, D
Feedback:
Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized
inflammation and BNP is relevant to heart failure; neither is included in a liver panel.
22. A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop
a nutritional plan. The nurse should prioritize which of the following in the patients plan?
A) Increased potassium intake
B) Fluid restriction to 2 L per day
C) Reduction in sodium intake
D) High-protein, low-fat diet
Ans: C
Feedback:
Patients with ascites require a sharp reduction in sodium intake. Potassium intake should not be
correspondingly increased. There is no need for fluid restriction or increased protein intake.
23. A nurse is amending a patients plan of care in light of the fact that the patient has recently developed
ascites. What should the nurse include in this patients care plan?
A) Mobilization with assistance at least 4 times daily
B) Administration of beta-adrenergic blockers as ordered
C) Vitamin B12 injections as ordered
D) Administration of diuretics as ordered
Ans: D
Feedback:
Use of diuretics along with sodium restriction is successful in 90% of patients with ascites. Beta-
blockers are not used to treat ascites and bed rest is often more beneficial than increased mobility.
Vitamin B12 injections are not necessary.
24. A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What
assessment should the nurse prioritize in this patients plan of care?
A) Measurement of abdominal girth and body weight
B) Assessment for variceal bleeding
C) Assessment for signs and symptoms of jaundice
D) Monitoring of results of liver function testing
Ans: B
Feedback:
Esophageal varices are a major cause of mortality in patients with uncompensated cirrhosis.
Consequently, this should be a focus of the nurses assessments and should be prioritized over the other
listed assessments, even though each should be performed.
25. A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo
variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this
phase of the patients treatment?
A) Decisional Conflict
Deficient Knowledge
B)
Death Anxiety
C)
Disturbed Thought Processes

D)
Ans: C
Feedback:
The sudden hemorrhage that accompanies variceal bleeding is intensely anxiety-provoking. The nurse
must address the patients likely fear of death, which is a realistic possibility. For most patients, anxiety is
likely to be a more acute concern than lack of knowledge or decisional conflict. The patient may or may
not experience disturbances in thought processes.
26. A patient with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of
this complication of liver disease. Following the completion of this diagnostic test, what nursing
intervention should the nurse perform?
A) Keep patient NPO until the results of test are known.
B) Keep patient NPO until the patients gag reflex returns.
C) Administer analgesia until post-procedure tenderness is relieved.
D) Give the patient a cold beverage to promote swallowing ability.
Ans: B
Feedback:
After the examination, fluids are not given until the patients gag reflex returns. Lozenges and gargles
may be used to relieve throat discomfort if the patients physical condition and mental status permit. The
result of the test is known immediately. Food and fluids are contraindicated until the gag reflex returns.
27. A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the
patient is at risk for hypovolemia. The patient has Ringers lactate at 150 cc/hr infusing. What else might
the nurse expect to have ordered to maintain volume for this patient?
A) Arterial line
B) Diuretics
C) Foley catheter
D) Volume expanders
Ans: D
Feedback:
Because patients with bleeding esophageal varices have intravascular volume depletion and are subject
to electrolyte imbalance, IV fluids with electrolytes and volume expanders are provided to restore fluid
volume and replace electrolytes. Diuretics would reduce vascular volume. An arterial line and Foley
catheter are likely to be ordered, but neither actively maintains the patients volume.
28. A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating
with the care team to plan this patients treatment, the nurse should anticipate what intervention?
A) Administration of immune globulins
B) A regimen of antiviral medications
C) Rest and watchful waiting
D) Administration of fresh-frozen plasma (FFP)
Ans: B
Feedback:
There is no benefit from rest, diet, or vitamin supplements in HCV treatment. Studies have demonstrated
that a combination of two antiviral agents, Peg-interferon and ribavirin (Rebetol), is effective in
producing improvement in patients with hepatitis C and in treating relapses. Immune globulins and FFP
are not indicated.
29. A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that
affect healthcare providers. What action has the greatest potential to reduce a nurses risk of acquiring
hepatitis C in the workplace?
A) Disposing of sharps appropriately and not recapping needles
B) Performing meticulous hand hygiene at the appropriate moments in care
C) Adhering to the recommended schedule of immunizations
D) Wearing an N95 mask when providing care for patients on airborne precautions
Ans: A
Feedback:
HCV is bloodborne. Consequently, prevention of needlestick injuries is paramount. Hand hygiene,

immunizations and appropriate use of masks are important aspects of overall infection control, but these
actions do not directly mitigate the risk of HCV.
30. A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning
the patients care, the nurse should be aware of what potential clinical course of this health problem?
Place the following events in the correct sequence.
1. Fever rises. 2. Hematemesis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma.
A) 1, 2, 5, 4, 3
B) 1, 2, 3, 4, 5
C) 2, 3, 1, 4, 5
D) 3, 1, 2, 5, 4
Ans: B
Feedback:
Recovery from acute toxic hepatitis is rapid if the hepatotoxin is identified early and removed or if
exposure to the agent has been limited. Recovery is unlikely if there is a prolonged period between
exposure and onset of symptoms. There are no effective antidotes. The fever rises; the patient becomes
toxic and prostrated. Vomiting may be persistent, with the emesis containing blood. Clotting
abnormalities may be severe, and hemorrhages may appear under the skin. The severe GI symptoms
may lead to vascular collapse. Delirium, coma, and seizures develop, and within a few days the patient
may die of fulminant hepatic failure unless he or she receives a liver transplant.
31. A previously healthy adults sudden and precipitous decline in health has been attributed to fulminant
hepatic failure, and the patient has been admitted to the intensive care unit. The nurse should be aware
that the treatment of choice for this patient is what?
A) IV administration of immune globulins
B) Transfusion of packed red blood cells and fresh-frozen plasma (FFP)
C) Liver transplantation
D) Lobectomy
Ans: C
Feedback:
Liver transplantation carries the highest potential for the resolution of fulminant hepatic failure. This is
preferred over other interventions, such as pharmacologic treatments, transfusions, and surgery.
32. A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurses most recent
assessment reveals subtle changes in the patients cognition and behavior. What is the nurses most
appropriate response?
A) Ensure that the patients sodium intake does not exceed recommended levels.
B) Report this finding to the primary care provider due to the possibility of hepatic encephalopathy.
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.
Ans: B
Feedback:
Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse
monitors the patients mental status closely and reports changes so that treatment of encephalopathy can
be initiated promptly. This change in status is likely unrelated to sodium intake and would not signal the
onset of hepatitis. A supportive care environment is beneficial, but does not address the patients
physiologic deterioration.
A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be
33. most appropriate when addressing the patients fluid volume excess? Select all that apply.
A) Administering diuretics
B) Administering calcium channel blockers
C) Implementing fluid restrictions
D) Implementing a 1500 kcal/day restriction
E) Enhancing patient positioning
Ans: A, C, E
Feedback:
Administering diuretics, implementing fluid restrictions, and enhancing patient positioning can optimize
the management of fluid volume excess. Calcium channel blockers and calorie restriction do not address
this problem.
34. A patient with liver cancer is being discharged home with a biliary drainage system in place. The nurse
should teach the patients family how to safely perform which of the following actions?
A) Aspirating bile from the catheter using a syringe
B) Removing the catheter when output is 15 mL in 24 hours
C) Instilling antibiotics into the catheter
D) Assessing the patency of the drainage catheter
Ans: D
Feedback:
Families should be taught to provide basic catheter care, including assessment of patency. Antibiotics
are not instilled into the catheter and aspiration using a syringe is contraindicated. The family would not
independently remove the catheter; this would be done by a member of the care team when deemed
necessary.
35. A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is
being considered by the interdisciplinary team. How will the patients prioritization for receiving a donor
liver be determined?
A) By considering the patients age and prognosis
B) By objectively determining the patients medical need
C) By objectively assessing the patients willingness to adhere to post-transplantation care
D) By systematically ruling out alternative treatment options
Ans: B
Feedback:
The patient would undergo a classification of the degree of medical need through an objective
determination known as the Model of End-Stage Liver Disease (MELD) classification, which stratifies
the level of illness of those awaiting a liver transplant. This algorithm considers multiple variables, not
solely age, prognosis, potential for adherence, and the rejection of alternative options.
36. A nurse has entered the room of a patient with cirrhosis and found the patient on the floor. The patient
states that she fell when transferring to the commode. The patients vital signs are within reference ranges
and the nurse observes no apparent injuries. What is the nurses most appropriate action?
A) Remove the patients commode and supply a bedpan.
B) Complete an incident report and submit it to the unit supervisor.
C) Have the patient assessed by the physician due to the risk of internal bleeding.
D) Perform a focused abdominal assessment in order to rule out injury.
Ans: C
Feedback:
A fall would necessitate thorough medical assessment due to the patients risk of bleeding. The nurses
abdominal assessment is an appropriate action, but is not wholly sufficient to rule out internal injury.
Medical assessment is a priority over removing the commode or filling out an incident report, even
though these actions are appropriate.
37. A patient with liver cancer is being discharged home with a hepatic artery catheter in place. The nurse
should be aware that this catheter will facilitate which of the following?
A) Continuous monitoring for portal hypertension
B) Administration of immunosuppressive drugs during the first weeks after transplantation
C) Real-time monitoring of vascular changes in the hepatic system
D) Delivery of a continuous chemotherapeutic dose
Ans: D
Feedback:
In most cases, the hepatic artery catheter has been inserted surgically and has a prefilled infusion pump
that delivers a continuous chemotherapeutic dose until completed. The hepatic artery catheter does not
monitor portal hypertension, deliver immunosuppressive drugs, or monitor vascular changes in the
hepatic system.
38. A nurse on a solid organ transplant unit is planning the care of a patient who will soon be admitted upon
immediate recovery following liver transplantation. What aspect of nursing care is the nurses priority?
A) Implementation of infection-control measures
B) Close monitoring of skin integrity and color

C) Frequent assessment of the patients psychosocial status
D) Administration of antiretroviral medications
Ans: A
Feedback:
Infection control is paramount following liver transplantation. This is a priority over skin integrity and
psychosocial status, even though these are valid areas of assessment and intervention. Antiretrovirals are
not indicated.
39. A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency
ablation. The nurse should recognize what goal of this treatment?
A) Destruction of the patients liver tumor
B) Restoration of portal vein patency
C) Destruction of a liver abscess
D) Reversal of metastasis
Ans: A
Feedback:
Using radiofrequency ablation, a tumor up to 5 cm in size can be destroyed in one treatment session.
This technique does not address circulatory function or abscess formation. It does not allow for the
reversal of metastasis.
40. A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be
24 mg/dL. For what complication is this patient at risk?
A) Chronic jaundice
B) Pigment stones in portal circulation
C) Central nervous system damage
D) Hepatomegaly
Ans: C
Feedback:
Prolonged jaundice, even if mild, predisposes to the formation of pigment stones in the gallbladder, and
extremely severe jaundice (levels of free bilirubin exceeding 20 to 25 mg/dL) poses a risk for CNS
damage. There are not specific risks of hepatomegaly or chronic jaundice resulting from high bilirubin.
Chapter 50: Assessment and Management of Patients with Biliary

Disorders

1. A nurse is assessing a patient who has been diagnosed with cholecystitis, and is experiencing localized
abdominal pain. When assessing the characteristics of the patients pain, the nurse should anticipate that
it may radiate to what region?
A) Left upper chest
B) Inguinal region
C) Neck or jaw
D) Right shoulder
Ans: D
Feedback:
The patient may have biliary colic with excruciating upper right abdominal pain that radiates to the back
or right shoulder. Pain from cholecystitis does not typically radiate to the left upper chest, inguinal area,
neck, or jaw.
2. A 55-year-old man has been newly diagnosed with acute pancreatitis and admitted to the acute medical
unit. How should the nurse most likely explain the pathophysiology of this patients health problem?
A) Toxins have accumulated and inflamed your pancreas.
B) Bacteria likely migrated from your intestines and became lodged in your pancreas.
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.
Ans: D
Feedback:
Although the mechanisms causing pancreatitis are unknown, pancreatitis is commonly described as the
autodigestion of the pancreas. Less commonly, toxic substances and microorganisms are implicated as
the cause of pancreatitis.
3. A patients assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is
performing the health interview, what assessment questions address likely etiologic factors? Select all
that apply.
A) How many alcoholic drinks do you typically consume in a week?
B) Have you ever been tested for diabetes?
C) Have you ever been diagnosed with gallstones?
D) Would you say that you eat a particularly high-fat diet?
E) Does anyone in your family have cystic fibrosis?
Ans: A, C
Feedback:
Eighty percent of patients with acute pancreatitis have biliary tract disease such as gallstones or a history
of long-term alcohol abuse. Diabetes, high-fat consumption, and cystic fibrosis are not noted etiologic
factors.
4. A patients abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patients
laboratory studies, what finding is most closely associated with this diagnosis?
A) Increased bilirubin
B) Decreased serum cholesterol
C) Increased blood urea nitrogen (BUN)
D) Decreased serum alkaline phosphatase level
Ans: A
Feedback:
If the flow of blood is impeded, bilirubin, a pigment derived from the breakdown of red blood cells, does
not enter the intestines. As a result, bilirubin levels in the blood increase. Cholesterol, BUN, and alkaline
phosphatase levels are not typically affected.
5. A nurse who provides care in a walk-in clinic assesses a wide range of individuals. The nurse should
identify which of the following patients as having the highest risk for chronic pancreatitis?
A) A 45-year-old obese woman with a high-fat diet

B) An 18-year-old man who is a weekend binge drinker
C) A 39-year-old man with chronic alcoholism
D) A 51-year-old woman who smokes one-and-a-half packs of cigarettes per day
Ans: C
Feedback:
Excessive and prolonged consumption of alcohol accounts for approximately 70% to 80% of all cases of
chronic pancreatitis.
6. A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and
vomiting and severe abdominal pain. The patients abdomen is rigid, and there is bruising to the patients
flank. The 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?
A) Severe pancreatitis with possible peritonitis
B) Acute cholecystitis
C) Chronic pancreatitis
D) Acute appendicitis with possible perforation
Ans: A
Feedback:
Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care.
Pain in pancreatitis is accompanied by nausea and vomiting that does not relieve the pain or nausea.
Abdominal guarding is present and a rigid or board-like abdomen may be a sign of peritonitis.
Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain
generally occurs 24 to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake
makes pancreatitis a more likely possibility than appendicitis or cholecystitis.
7. A patient has been scheduled for an ultrasound of the gallbladder the following morning. What should
the nurse do in preparation for this diagnostic study?
A) Have the patient refrain from food and fluids after midnight.
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.
Ans: A
Feedback:
An ultrasound of the gallbladder is most accurate if the patient fasts overnight, so that the gallbladder is
distended. Contrast and radioactive agents are not used when performing ultrasonography of the
gallbladder, as an ultrasound is based on reflected sound waves.
8. A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from
postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment
finding to the physician?
A) Decreased breath sounds
B) Drainage of bile-colored fluid onto the abdominal dressing
C) Rigidity of the abdomen
D) Acute pain with movement
Ans: C
Feedback:
The location of the subcostal incision will likely cause the patient to take shallow breaths to prevent
pain, which may result in decreased breath sounds. The nurse should remind patients to take deep
breaths and cough to expand the lungs fully and prevent atelectasis. Acute pain is an expected
assessment finding following surgery; analgesics should be administered for pain relief. Abdominal
splinting or application of an abdominal binder may assist in reducing the pain. Bile may continue to
drain from the drainage tract after surgery, which will require frequent changes of the abdominal
dressing. Increased abdominal tenderness and rigidity should be reported immediately to the physician,
as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the
surgical procedure.
9. A patient with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago for relief of pain
and to restore drainage of pancreatic secretions. The patient has come to the office for a routine
postsurgical appointment. The patient is frustrated that the pain has not decreased. What is the most
appropriate initial response by the nurse?
A) The majority of patients who have a pancreaticojejunostomy have their normal digestion restored
but do not achieve pain relief.
B) Pain relief occurs by 6 months in most patients who undergo this procedure, but some people
experience a recurrence of their pain.
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.
Ans: B
Feedback:
Pain relief from a pancreaticojejunostomy often occurs by 6 months in more than 85% of the patients
who undergo this procedure, but pain returns in a substantial number of patients as the disease
progresses. This patient had surgery 3 months ago; the patient has 3 months before optimal benefits of
the procedure may be experienced. There is no obvious indication for gallbladder removal and
nonadherence is not the most likely factor underlying the pain.
10. A nurse is caring for a patient who has been scheduled for endoscopic retrograde
cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this
patient, the nurse should describe what aspect of this diagnostic procedure?
A) The need to protect the incision postprocedure
B) The use of moderate sedation
C) The need to infuse 50% dextrose during the procedure
D) The use of general anesthesia
Ans: B
Feedback:
Moderate sedation, not general anesthesia, is used during ERCP. D50 is not administered and the
procedure does not involve the creation of an incision.
11. A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home.
When providing health education, the nurse should prioritize which of the following topics?
A) Management of fluid balance in the home setting
B) The need for blood glucose monitoring for the next week
C) Signs and symptoms of intra-abdominal complications
D) Appropriate use of prescribed pancreatic enzymes

Ans: C
Feedback:
Because of the early discharge following laparoscopic cholecystectomy, the patient needs thorough
education in the signs and symptoms of complications. Fluid balance is not typically a problem in the
recovery period after laparoscopic cholecystectomy. There is no need for blood glucose monitoring or
pancreatic enzymes.
12. A nurse is preparing a plan of care for a patient with pancreatic cysts that have necessitated drainage
through the abdominal wall. What nursing diagnosis should the nurse prioritize?
Disturbed Body Image

A)
Impaired Skin Integrity

B)
C) Nausea
D) Risk for Deficient Fluid Volume
Ans: B
Feedback:
While each of the diagnoses may be applicable to a patient with pancreatic drainage, the priority nursing
diagnosis is Impaired Skin Integrity. The drainage is often perfuse and destructive to tissue because of
the enzyme contents. Nursing measures must focus on steps to protect the skin near the drainage site
from excoriation. The application of ointments or the use of a suction apparatus protects the skin from
excoriation.
13. A home health nurse is caring for a patient discharged home after pancreatic surgery. The nurse
documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than Body Requirements on the
care plan based on the potential complications that may occur after surgery. What are the most likely
complications for the patient who has had pancreatic surgery?
A) Proteinuria and hyperkalemia
B) Hemorrhage and hypercalcemia
C) Weight loss and hypoglycemia
D) Malabsorption and hyperglycemia
Ans: D
Feedback:
The nurse arrives at this diagnosis based on the complications of malabsorption and hyperglycemia.
These complications often lead to the need for dietary modifications. Pancreatic enzyme replacement, a
low-fat diet, and vitamin supplementation often are also required to meet the patients nutritional needs
and restrictions. Electrolyte imbalances often accompany pancreatic disorders and surgery, but the
electrolyte levels are more often deficient than excessive. Hemorrhage is a complication related to
surgery, but not specific to the nutritionally based nursing diagnosis. Weight loss is a common
complication, but hypoglycemia is less likely.
14. A patient has had a laparoscopic cholecystectomy. The patient is now complaining of right shoulder
pain. What should the nurse suggest to relieve the pain?
A) Aspirin every 4 to 6 hours as ordered
B) Application of heat 15 to 20 minutes each hour
C) Application of an ice pack for no more than 15 minutes
D) Application of liniment rub to affected area
Ans: B
Feedback:
If pain occurs in the right shoulder or scapular area (from migration of the CO2 used to insufflate the
abdominal cavity during the procedure), the nurse may recommend use of a heating pad for 15 to 20
minutes hourly, walking, and sitting up when in bed. Aspirin would constitute a risk for bleeding.
15. A patient returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the patient
for signs and symptoms of what serious potential complication of this surgery?
A) Diabetic coma
B) Decubitus ulcer
C) Wound evisceration
D) Bile duct injury
Ans: D
Feedback:
The most serious complication after laparoscopic cholecystectomy is a bile duct injury. Patients do not
face a risk of diabetic coma. A decubitus ulcer is unlikely because immobility is not expected.
Evisceration is highly unlikely, due to the laparoscopic approach.
16. A patient has been treated in the hospital for an episode of acute pancreatitis. The patient has
acknowledged the role that his alcohol use played in the development of his health problem, but has not
expressed specific plans for lifestyle changes after discharge. What is the nurses most appropriate
response?
A) Educate the patient about the link between alcohol use and pancreatitis.
B) Ensure that the patient knows the importance of attending follow-up appointments.
C) Refer the patient to social work or spiritual care.
D) Encourage the patient to connect with a community-based support group.
Ans: D
Feedback:
After the acute attack has subsided, some patients may be inclined to return to their previous drinking
habits. The nurse provides specific information about resources and support groups that may be of
assistance in avoiding alcohol in the future. Referral to Alcoholics Anonymous as appropriate or other
support groups is essential. The patient already has an understanding of the effects of alcohol, and
follow-up appointments will not necessarily result in lifestyle changes. Social work and spiritual care
may or may not be beneficial.
17. A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a
diagnosis of Ineffective Breathing Pattern Related to Pain. What intervention should the nurse perform
in order to best address this diagnosis?
A) Position the patient supine to facilitate diaphragm movement.
B) Administer corticosteroids by nebulizer as ordered.
C) Perform oral suctioning as needed to remove secretions.
D) Maintain the patient in a semi-Fowlers position whenever possible.
Ans: D
Feedback:
The nurse maintains the patient in a semi-Fowlers position to decrease pressure on the diaphragm by a
distended abdomen and to increase respiratory expansion. A supine position will result in increased
pressure on the diaphragm and potentially decreased respiratory expansion. Steroids and oral suctioning
are not indicated.
18. A patient with gallstones has been prescribed ursodeoxycholic acid (UDCA). The nurse understands that
additional teaching is needed regarding this medication when the patient states:
A) It is important that I see my physician for scheduled follow-up appointments while taking this
medication.
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.
Ans: B
Feedback:
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones composed
primarily of cholesterol. This drug can reduce the size of existing stones, dissolve small stones, and
prevent new stones from forming. Six to 12 months of therapy is required in many patients to dissolve
stones, and monitoring of the patient is required during this time. The effective dose of medication
depends on body weight.
19. A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient
admitted with acute gallbladder inflammation, the nurse will question which of the following foods on
the tray?
A) Fried chicken
B) Mashed potatoes
C) Dinner roll
D) Tapioca pudding
Ans: A
Feedback:
The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked
fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated.
The patient should avoid fried foods such as fried chicken, as fatty foods may bring on an episode of
cholecystitis.
20. A nurse is assessing an elderly patient with gallstones. The nurse is aware that the patient may not
exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly patient may
include what?
A) Fever and pain

B) Chills and jaundice
C) Nausea and vomiting
D) Signs and symptoms of septic shock
Ans: D
Feedback:
The elderly patient may not exhibit the typical symptoms of fever, pain, chills jaundice, and nausea and
vomiting. Symptoms of biliary tract disease in the elderly may be accompanied or preceded by those of
septic shock, which include oliguria, hypotension, change in mental status, tachycardia, and tachypnea.
21. A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced
activity. What rationale for this intervention should be cited in the care plan?
A) Bed rest reduces the patients metabolism and reduces the risk of metabolic acidosis.
B) Reduced activity protects the physical integrity of pancreatic cells.
C) Bed rest lowers the metabolic rate and reduces enzyme production.
D) Inactivity reduces caloric need and gastrointestinal motility.
Ans: C
Feedback:
The acutely ill patient is maintained on bed rest to decrease the metabolic rate and reduce the secretion
of pancreatic and gastric enzymes. Staying in bed does not release energy from the body to fight the
disease.
22. The nurse is caring for a patient who has just returned from the ERCP removal of gallstones. The nurse
should monitor the patient for signs of what complications?
A) Pain and peritonitis
B) Bleeding and perforation
C) Acidosis and hypoglycemia
D) Gangrene of the gallbladder and hyperglycemia

Ans: B
Feedback:
Following ERCP removal of gallstones, the patient is observed closely for bleeding, perforation, and the
development of pancreatitis or sepsis. Blood sugar alterations, gangrene, peritonitis, and acidosis are less
likely complications.
23. A patient with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple
procedure). During health education, the patient should be informed that this procedure will involve the
removal of which of the following? Select all that apply.
A) Gallbladder
B) Part of the stomach
C) Duodenum
D) Part of the common bile duct
E) Part of the rectum
Ans: A, B, C, D
Feedback:
A pancreaticoduodenectomy (Whipple procedure or resection) is used for potentially resectable cancer

of the head of the pancreas (Fig. 50-7). This procedure involves removal of the gallbladder, a portion of
the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. The
rectum is not affected.
24. An adult patient has been admitted to the medical unit for the treatment of acute pancreatitis. What
nursing action should be included in this patients plan of care?
A) Measure the patients abdominal girth daily.
B) Limit the use of opioid analgesics.
C) Monitor the patient for signs of dysphagia.
D) Encourage activity as tolerated.
Ans: A
Feedback:
Due to the risk of ascites, the nurse should monitor the patients abdominal girth. There is no specific
need to avoid the use of opioids or to monitor for dysphagia, and activity is usually limited.
25. A community health nurse is caring for a patient whose multiple health problems include chronic
pancreatitis. During the most recent visit, the nurse notes that the patient is experiencing severe
abdominal pain and has vomited 3 times in the past several hours. What is the nurses most appropriate
action?
A) Administer a PRN dose of pancreatic enzymes as ordered.
B) Teach the patient about the importance of abstaining from alcohol.
C) Arrange for the patient to be transported to the hospital.
D) Insert an NG tube, if available, and stay with the patient.
Ans: C
Feedback:
Chronic pancreatitis is characterized by recurring attacks of severe upper abdominal and back pain,
accompanied by vomiting. The onset of these acute symptoms warrants hospital treatment. Pancreatic
enzymes are not indicated and an NG tube would not be inserted in the home setting. Patient education is
a later priority that may or may not be relevant.
26. A student nurse is caring for a patient who has a diagnosis of acute pancreatitis and who is receiving
parenteral nutrition. The student should prioritize which of the following assessments?
A) Fluid output
B) Oral intake
C) Blood glucose levels
D) BUN and creatinine levels
Ans: C
Feedback:
In addition to administering enteral or parenteral nutrition, the nurse monitors serum glucose levels
every 4 to 6 hours. Output should be monitored but in most cases it is not more important than serum
glucose levels. A patient on parenteral nutrition would have no oral intake to monitor. Blood sugar levels
are more likely to be unstable than indicators of renal function.
27. A patient has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine
pancreatic islet cell function. The nurse should anticipate what diagnostic test?
A) Glucose tolerance test
B) ERCP
C) Pancreatic biopsy
D) Abdominal ultrasonography
Ans: A
Feedback:
A glucose tolerance test evaluates pancreatic islet cell function and provides necessary information for
making decisions about surgical resection of the pancreas. This specific clinical information is not
provided by ERCP, biopsy, or ultrasound.
28. A patient has been admitted to the hospital for the treatment of chronic pancreatitis. The patient has been
stabilized and the nurse is now planning health promotion and educational interventions. Which of the
following should the nurse prioritize?
A) Educating the patient about expectations and care following surgery
B) Educating the patient about the management of blood glucose after discharge
C) Educating the patient about postdischarge lifestyle modifications
D) Educating the patient about the potential benefits of pancreatic transplantation
Ans: C
Feedback:
The patients lifestyle (especially regarding alcohol use) is a major determinant of the course of chronic
pancreatitis. The disease is not often managed by surgery and blood sugar monitoring is not necessarily
indicated for every patient after hospital treatment. Transplantation is not an option.
29. The family of a patient in the ICU diagnosed with acute pancreatitis asks the nurse why the patient has
been moved to an air bed. What would be the nurses best response?
A) Air beds allow the care team to reposition her more easily while shes on bed rest.
B) Air beds are far more comfortable than regular beds and shell likely have to be on bed rest a long
time.
C) The bed automatically moves, so shes less likely to develop pressure sores while shes in bed.
D) The bed automatically moves, so she is likely to have less pain.
Ans: C
Feedback:
It is important to turn the patient every 2 hours; use of specialty beds may be indicated to prevent skin
breakdown. The rationale for a specialty bed is not related to repositioning, comfort, or ease of
movement.
30. A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that
pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis.
Consequently, the nurse should assess for what signs or symptoms of this complication?
A) Sudden increase in random blood glucose readings
B) Increased abdominal girth accompanied by decreased level of consciousness
C) Fever, increased heart rate and decreased blood pressure
D) Abdominal pain unresponsive to analgesics
Ans: C
Feedback:
Pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis
because of resulting hemorrhage, septic shock, and multiple organ dysfunction syndrome (MODS).
Signs of shock would include hypotension, tachycardia and fever. Each of the other listed changes in
status warrants intervention, but none is clearly suggestive of an onset of pancreatic necrosis.
31. A patient has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute
Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this
patient?
A) Oral oxycodone
B) IV hydromorphone (Dilaudid)
C) IM meperidine (Demerol)
D) Oral naproxen (Aleve)
Ans: B
Feedback:
The pain of acute pancreatitis is often very severe and pain relief may require parenteral opioids such as
morphine, fentanyl (Sublimaze), or hydromorphone (Dilaudid). There is no clinical evidence to support
the use of meperidine for pain relief in pancreatitis. Opioids are preferred over NSAIDs.
32. A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe
pain and diagnostic testing indicates that over 80% of the patients pancreas has been destroyed. The
patient asks the nurse why the diagnosis was not made earlier in the disease process. What would be the
nurses best response?
A) The symptoms of pancreatitis mimic those of much less serious illnesses.
B) Your body doesnt require pancreatic function until it is under great stress, so it is easy to go
unnoticed.
C) Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost.
D) Its likely that your other organs were compensating for your decreased pancreatic function.
Ans: C
Feedback:
By the time symptoms occur in chronic pancreatitis, approximately 90% of normal acinar cell function
(exocrine function) has been lost. Late detection is not usually attributable to the vagueness of
symptoms. The pancreas contributes continually to homeostasis and other organs are unable to perform
its physiologic functions.
33. A patient has been diagnosed with pancreatic cancer and has been admitted for care. Following initial
treatment, the nurse should be aware that the patient is most likely to require which of the following?
A) Inpatient rehabilitation
B) Rehabilitation in the home setting
C) Intensive physical therapy
D) Hospice care
Ans: D
Feedback:
Pancreatic carcinoma has only a 5% survival rate at 5 years regardless of the stage of disease at
diagnosis or treatment. As a result, there is a higher likelihood that the patient will require hospice care
than physical therapy and rehabilitation.
34. A patient is admitted to the ICU with acute pancreatitis. The patients family asks what causes acute
pancreatitis. The critical care nurse knows that a majority of patients with acute pancreatitis have what?
A) Type 1 diabetes
B) An impaired immune system
C) Undiagnosed chronic pancreatitis
D) An amylase deficiency
Ans: C
Feedback:
Eighty percent of patients with acute pancreatitis have biliary tract disease or a history of long-term
alcohol abuse. These patients usually have had undiagnosed chronic pancreatitis before their first
episode of acute pancreatitis. Diabetes, an impaired immune function, and amylase deficiency are not
specific precursors to acute pancreatitis.
35. A patient is admitted to the unit with acute cholecystitis. The physician has noted that surgery will be
scheduled in 4 days. The patient asks why the surgery is being put off for a week when he has a sick
gallbladder. What rationale would underlie the nurses response?
A) Surgery is delayed until the patient can eat a regular diet without vomiting.
B) Surgery is delayed until the acute symptoms subside.
C) The patient requires aggressive nutritional support prior to surgery.
D) Time is needed to determine whether a laparoscopic procedure can be used.
Ans: B
Feedback:
Unless the patients condition deteriorates, surgical intervention is delayed just until the acute symptoms
subside (usually within a few days). There is no need to delay surgery pending an improvement in
nutritional status, and deciding on a laparoscopic approach is not a lengthy process.
36. A patient with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is
laparoscopic cholecystectomy preferred by surgeons over an open procedure?
A) Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.
B) Laparoscopic cholecystectomy can be performed in a clinic 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.
Ans: A
Feedback:
Open surgery has largely been replaced by laparoscopic cholecystectomy (removal of the gallbladder
through a small incision through the umbilicus). As a result, surgical risks have decreased, along with
the length of hospital stay and the long recovery period required after standard surgical cholecystectomy.
Both approaches allow for removal of the entire gallbladder and must be performed under general
anesthetic in an operating theater.
37. A patient with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis
secondary to gallstones. The nurse should anticipate that the patient will undergo what intervention?
A) Laparoscopic cholecystectomy
B) Methyl tertiary butyl ether (MTBE) infusion
C) Intracorporeal lithotripsy
D) Extracorporeal shock wave therapy (ESWL)
Ans: A
Feedback:
Most of the nonsurgical approaches, including lithotripsy and dissolution of gallstones, provide only
temporary solutions to gallstone problems and are infrequently used in the United States.
Cholecystectomy is the preferred treatment.
A nurse is caring for a patient with gallstones who has been prescribed ursodeoxycholic acid (UDCA).
38. The patient askshow this medicine is going to help his symptoms. The nurse should be aware of what
aspect of this drugs pharmacodynamics?
A) It inhibits the synthesis of bile.

B) It inhibits the synthesis and secretion of cholesterol.
C) It inhibits the secretion of bile.
D) It inhibits the synthesis and secretion of amylase.
Ans: B
Feedback:
UDCA acts by inhibiting the synthesis and secretion of cholesterol, thereby desaturating bile. UDCA
does not directly inhibit either the synthesis or secretion of bile or amylase.
39. A nurse is providing discharge education to a patient who has undergone a laparoscopic
cholecystectomy. During the immediate recovery period, the nurse should recommend what foods?
A) High-fiber foods
B) Low-purine, nutrient-dense foods
C) Low-fat foods high in proteins and carbohydrates
D) Foods that are low-residue and low in fat
Ans: C
Feedback:
The nurse encourages the patient to eat a diet that is low in fats and high in carbohydrates and proteins
immediately after surgery. There is no specific need to increase fiber or avoid purines. A low-residue
diet is not indicated.
40. A patient presents to the emergency department (ED) complaining of severe right upper quadrant pain.
The patient states that his family doctor told him he had gallstones. The ED nurse should recognize what
possible complication of gallstones?
A) Acute pancreatitis
B) Atrophy of the gallbladder
C) Gallbladder cancer
D) Gangrene of the gallbladder

Ans: D
Feedback:
In calculous cholecystitis, a gallbladder stone obstructs bile outflow. Bile remaining in the gallbladder
initiates a chemical reaction; autolysis and edema occur; and the blood vessels in the gallbladder are
compressed, compromising its vascular supply. Gangrene of the gallbladder with perforation may result.
Pancreatitis, atrophy, and cancer of the gallbladder are not plausible complications.
Chapter 51: Assessment and Management of Patients with Diabetes

1. A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive.
What is the nurses most plausible conclusion based on this assessment finding?
A) The patient should withhold his next scheduled dose of insulin.
B) The patient should promptly eat some protein and carbohydrates.
C) The patients insulin levels are inadequate.
D) The patient would benefit from a dose of metformin (Glucophage).
Ans: C
Feedback:
Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is
deteriorating. Withholding insulin or eating food would exacerbate the patients ketonuria. Metformin
will not cause short-term resolution of hyperglycemia.
2. A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would
support checking blood levels for the diagnosis of diabetes?
A) Fasting plasma glucose greater than or equal to 126 mg/dL
B) Random plasma glucose greater than 150 mg/dL
C) Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions
D) Random plasma glucose greater than 126 mg/dL
Ans: A
Feedback:
Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater
than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.
3. A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline
would be important to teach the patients at this class?
A) Low fat generally indicates low sugar.

B) Protein should constitute 30% to 40% of caloric intake.
C) Most calories should be derived from carbohydrates.
D) Animal fats should be eliminated from the diet.
Ans: C
Feedback:
Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic
Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived
from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.Low fat does not
automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.
4. A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus
and her family. The nurse teaches the patient and family that which of the following nonpharmacologic
measures will decrease the bodys need for insulin?
A) Adequate sleep
B) Low stimulation
C) Exercise
D) Low-fat diet
Ans: C
Feedback:
Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride
levels. Low fat intake and low levels of stimulation do not reduce a patients need for insulin. Adequate
sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.
5. A medical nurse is caring for a patient with type 1 diabetes. The patients medication administration
record includes the administration of regular insulin three times daily. Knowing that the patients lunch
tray will arrive at 11:45, when should the nurse administer the patients insulin?
A) 10:45
B) 11:15
C) 11:45
D) 11:50
Ans: B
Feedback:
Regular insulin is usually administered 2030 min before a meal. Earlier administration creates a risk for
hypoglycemia; later administration creates a risk for hyperglycemia.
6. A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic
agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood
glucose. What type of oral antidiabetic agent did the physician prescribe for this patient?
A) A sulfonylurea
B) A biguanide
C) A thiazolidinedione
D) An alpha glucosidase inhibitor
Ans: B
Feedback:
Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and
therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by
the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance
insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas.
Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system,
resulting in a lower postprandial blood glucose level.
7. A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What
guideline applies to periods of illness in a diabetic patient?
A) Do not eliminate insulin when nauseated and vomiting.
B) Report elevated glucose levels greater than 150 mg/dL.
C) Eat three substantial meals a day, if possible.
D) Reduce food intake and insulin doses in times of illness.
Ans: A
Feedback:
The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses
when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent
dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels
will rise but should be reported if they are greater than 300 mg/dL.
8. The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address
what topic during this dialogue?
A) The need for frequent eye examinations for patients with diabetes
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
Ans: B
Feedback:
Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the
effects on vision and renal function are considered to be microvascular.
9. A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the
following actions has the greatest potential to reduce an individuals risk for developing diabetes?
A) Have blood glucose levels checked annually.
B) Stop using tobacco in any form.
C) Undergo eye examinations regularly.
D) Lose weight, if obese.
Ans: D
Feedback:
Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease.
Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not
screen for the disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes.
10. A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is
subsequently diagnosed with diabetes. Based on the fact that the childs pancreatic beta cells are being
destroyed, the patient would be diagnosed with what type of diabetes?
A) Type 1 diabetes
B) Type 2 diabetes
C) Noninsulin-dependent diabetes
D) Prediabetes
Ans: A
Feedback:
Beta cell destruction is the hallmark of type 1 diabetes. Noninsulin-dependent diabetes is synonymous
with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell
destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of
hyperglycemia, often during illness or pregnancy.
11. A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse
is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?
A) The tissues in your body are resistant to the action of insulin, making the glucose levels in your
blood increase.
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.
Ans: D
Feedback:
Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin
production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose
derived from food cannot be stored in the liver and remains circulating in the blood, which leads to
postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion.
The body does not make glucose.
12. An occupational health nurse is screening a group of workers for diabetes. What statement should the
nurse interpret as suggestive of diabetes?
A) Ive always been a fan of sweet foods, but lately Im turned off by them.
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.
Ans: B
Feedback:
Classic clinical manifestations of diabetes include the three Ps: polyuria, polydipsia, and polyphagia.
Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.
13. A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient
understands the primary treatment for type 2 diabetes when the patient states what?
A) I read that a pancreas transplant will provide a cure for my diabetes.
B) I will take my oral antidiabetic agents when my morning 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.
Ans: C
Feedback:
Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss.
Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose
levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory
levels, additional oral agents may be used. Some patients may require insulin on an ongoing basis or on
a temporary basis during times of acute psychological stress, but it is not the central component of type 2
treatment. Pancreas transplantation is associated with type 1 diabetes.
14. A diabetes nurse educator is presenting the American Diabetes Association (ADA) recommendations for
levels of caloric intake. What do the ADAs recommendations include?
A) 10% of calories from carbohydrates, 50% from fat, and the remaining 40% from protein
B) 10% to 20% of calories from carbohydrates, 20% to 30% 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
Ans: D
Feedback:
Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic
Association) recommend that for all levels of caloric intake, 50% to 60% of calories come 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 the emergency department by his daughter. The
patient is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the
patient recently 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?
A) Administration of antihypertensive medications
B) Administering sodium bicarbonate intravenously
C) Reversing acidosis by administering insulin
D) Fluid and electrolyte replacement
Ans: D
Feedback:
The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and
insulin administration. Antihypertensive medications are not indicated, as hypotension generally
accompanies HHS due to dehydration. Sodium bicarbonate is not administered to patients with HHS, as
their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the
treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).
16. A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the
best way to assess the patients ability to prepare and self-administer insulin?
A) Ask the patient to describe the process in detail.
B) Observe the patient drawing up and administering the insulin.
C) Provide a health education session reviewing the main points of insulin delivery.
D) Review the patients first hemoglobin A1C result after discharge.
Ans: B
Feedback:
Nurses should assess the patients ability to perform diabetes related self-care as soon as possible during
the hospitalization or office visit to determine whether the patient requires further diabetes teaching.
While consulting a home care nurse is beneficial, an initial assessment should be performed during the
hospitalization or office visit. Nurses should directly observe the patient performing the skills such as
insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the
patient about these skills without actually observing performance of the skill is not sufficient. Further
education does not guarantee learning.
17. An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about
foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot
care is extremely important. Why would the nurse feel that foot care is so important to this patient?
A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy.
B) Avoiding foot ulcers may mean the difference between institutionalization and continued
independent living.
C) Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes.
Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower
D) extremities.
Ans: B
Feedback:
The nurse recognizes that providing information on the long-term complicationsespecially foot and eye
problemsassociated with diabetes is important. Avoiding amputation through early detection of foot
ulcers may mean the difference between institutionalization and continued independent living for the
elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and
may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in
circulation is related to vascular changes and is not associated with drugs administered for diabetes.
18. A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is
aware that the patient will require further teaching when the patient states what?
A) I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar
every 2 hours.
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.
Ans: A
Feedback:
The nurse must explanation the sick day rules again to the patient who plans to stop taking insulin when
sick. The nurse should emphasize that the patient should take insulin agents as usual and test ones blood
sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental
doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater
than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to
eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding.
If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60
minutes to prevent dehydration.
19. Which of the following patients with type 1 diabetes is most likely to experience adequate glucose
control?
A) A patient who skips breakfast when his glucose reading is 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
Ans: C
Feedback:
The therapeutic goal for diabetes management is to achieve normal blood glucose levels without
hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the
treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by
patients. For patients who require insulin to help control blood glucose levels, maintaining consistency
in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the
approximate time intervals between meals, and the snacks, help maintain overall glucose control.
Skipping meals is never advisable for person with type 1 diabetes.
20. A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance
test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is
conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should
explain that gestational diabetes is a result of what etiologic factor?
A) Increased caloric intake during the first trimester

B) Changes in osmolality and fluid balance
C) The effects of hormonal changes during pregnancy
D) Overconsumption of carbohydrates during the first two trimesters
Ans: C
Feedback:
Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion of
placental hormones, which causes insulin resistance. The disease is not the result of food intake or
changes in osmolality.
21. A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic
hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome
most often occur?
A) Patients who are obese and who have no known history of diabetes
B) Patients with type 1 diabetes and poor dietary control
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
Ans: D
Feedback:
HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or
who have type 2 diabetes.
22. A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient
about self-administration of insulin in the home setting. The nurse should teach the patient to do which
of the following?
A) Avoid using the same injection site more than once in 2 to 3 weeks.
B) Avoid mixing more than one type of insulin in a syringe.
C) Cleanse the injection site thoroughly with alcohol prior to injecting.
D) Inject at a 45 angle.
Ans: A
Feedback:
To prevent lipodystrophy, the patient should try not to use the same site more than once in 2 to 3 weeks.
Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is
usually inserted at a 90 angle. Cleansing the injection site with alcohol is optional.
23. A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being
admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on
two occasions. The nurse would identify what likely cause for this short-term change in treatment?
A) Alterations in bile metabolism and release have likely caused hyperglycemia.
B) Stress has likely caused an increase in the patients blood sugar levels.
C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologic
measures.
D) The patients volatile fluid balance surrounding surgery has likely caused unstable blood sugars.
Ans: B
Feedback:
During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because
levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone)
increase. The patients need for insulin is unrelated to the action of bile, the patients overestimation of
previous blood sugar control, or fluid imbalance.
24. A physician has explained to a patient that he has developed diabetic neuropathy in his right foot. Later
that day, the patient asks the nurse what causes diabetic neuropathy. What would be the nurses best
response?
A) Research has shown that diabetic neuropathy is caused by fluctuations in blood sugar that have
gone on for years.
B) The cause is not known for sure but it is thought to have 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.
Ans: C
Feedback:
The etiology of neuropathy may involve elevated blood glucose levels over a period of years. High
blood sugars (rather than fluctuations or variations in blood sugars) are thought to be responsible.
Ketones and ketoacidosis are not direct causes of neuropathies.
25. A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin
(Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should
prioritize which of the following assessments?
A) Monitoring the patients neutrophil levels
B) Assessing the patient for signs of impaired liver function
C) Monitoring the patients level of consciousness and behavior
D) Reviewing the patients creatinine and BUN levels
Ans: D
Feedback:
Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patients renal
function. This drug does not typically affect patients neutrophils, liver function, or cognition.
26. A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The
nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy.
Peripheral neuropathy constitutes a risk for what nursing diagnosis?
A) Infection
B) Acute pain
C) Acute confusion
D) Impaired urinary elimination
Ans: A
Feedback:
Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury
and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not
normally result in pain, confusion, or impairments in urinary function.
27. A patient has been brought to the emergency department by paramedics after being found unconscious.
The patients Medic Alert bracelet indicates that the patient has type 1 diabetes and the patients blood
glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention?
A) IV administration of 50% dextrose in water
B) Subcutaneous administration of 10 units of Humalog
C) Subcutaneous administration of 12 to 15 units of regular insulin
D) IV bolus of 5% dextrose in 0.45% NaCl
Ans: A
Feedback:
In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50
mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five
percent dextrose would be inadequate and insulin would exacerbate the patients condition.
28. A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing
information on the prevention and management of hypoglycemia, what action should the nurse promote?
A) Always carry a form of fast-acting sugar.
B) Perform exercise prior to eating whenever possible.
C) Eat a meal or snack every 8 hours.
D) Check blood sugar at least every 24 hours.
Ans: A
Feedback:
The following teaching points should be included in information provided to the patient on how to
prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a
meal or snack every 4 to 5 hours, and check blood sugar regularly.
29. A nurse is teaching basic survival skills to a patient newly diagnosed with type 1 diabetes. What topic
should the nurse address?
A) Signs and symptoms of diabetic nephropathy
B) Management of diabetic ketoacidosis

C) Effects of surgery and pregnancy on blood sugar levels
D) Recognition of hypoglycemia and hyperglycemia
Ans: D
Feedback:
It is imperative that newly diagnosed patients know the signs and symptoms and management of hypo-
and hyperglycemia. The other listed topics are valid points for education, but are not components of the
patients immediate survival skills following a new diagnosis.
30. A nurse is conducting a class on how to self-manage insulin regimens. A patient asks how long a vial of
insulin can be stored at room temperature before it goes bad. What would be the nurses best answer?
A) If you are going to use up the vial within 1 month it can be kept at room temperature.
B) If a vial of insulin will be used up within 21 days, it may be 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.
Ans: A
Feedback:
If a vial of insulin will be used up within 1 month, it may be kept at room temperature.
31. A patient has received a diagnosis of type 2 diabetes. The diabetes nurse has made contact with the
patient and will implement a program of health education. What is the nurses priority action?
Ensure that the patient understands the basic pathophysiology of diabetes.

A)
B) Identify the patients body mass index.
C) Teach the patient survival skills for diabetes.
D) Assess the patients readiness to learn.
Ans: D
Feedback:
Before initiating diabetes education, the nurse assesses the patients (and familys) readiness to learn. This
must precede other physiologic assessments (such as BMI) and providing health education.
32. A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses
the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8
mmol/L). What should the school nurse administer?
A) A combination of protein and carbohydrates, such as a small cup of yogurt
B) Two teaspoons of sugar dissolved in a cup of apple juice
C) Half of a cup of juice, followed by cheese and crackers
D) Half a sandwich with a protein-based filling
Ans: C
Feedback:
Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose
tablets, 1 tube glucose gel, or 0.5 cup juice. After initial treatment, the nurse should follow with a snack
including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is
unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in
juice contains enough simple carbohydrate to raise the blood glucose level and additional sugar may
result in a sharp rise in blood sugar that will last for several hours.
33. A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for
diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patients initial phase
of treatment?
A) Monitoring the patient for dysrhythmias
B) Maintaining and monitoring the patients fluid balance
C) Assessing the patients level of consciousness
D) Assessing the patient for signs and symptoms of venous thromboembolism
Ans: B
Feedback:
In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration,

electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor
the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance
is the highest priority.
34. A patient has been living with type 2 diabetes for several years, and the nurse realizes that the patient is
likely to have minimal contact with the health care system. In order to ensure that the patient maintains
adequate blood sugar control over the long term, the nurse should recommend which of the following?
A) Participation in a support group for persons with diabetes
B) Regular consultation of websites that address diabetes management
C) Weekly telephone check-ins with an endocrinologist
D) Participation in clinical trials relating to antihyperglycemics
Ans: A
Feedback:
Participation in support groups is encouraged for patients who have had diabetes for many years as well
as for those who are newly diagnosed. This is more interactive and instructive than simply consulting
websites. Weekly telephone contact with an endocrinologist is not realistic in most cases. Participation
in research trials may or may not be beneficial and appropriate, depending on patients circumstances.
35. A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority
instruction for the nurse to give the patient?
A) Examine feet weekly for redness, blisters, and abrasions.
B) Avoid the use of moisturizing lotions.
C) Avoid hot-water bottles and heating pads.
D) Dry feet vigorously after each bath.
Ans: C
Feedback:
High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes,
soaking the feet, and shaving calluses, should be avoided.
Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling,
redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After
a bath, the patient should gently, not vigorously, pat feet dry to avoid injury.
36. A diabetes nurse is assessing a patients knowledge of self-care skills. What would be the most
appropriate way for the educator to assess the patients knowledge of nutritional therapy in diabetes?
A) Ask the patient to describe an optimally healthy meal.

B) Ask the patient to keep a food diary and review it with the nurse.
C) Ask the patients family what he typically eats.
D) Ask the patient to describe a typical days food intake.
Ans: B
Feedback:
Reviewing the patients actual food intake is the most accurate method of gauging the patients diet.
37. The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the
presence of microalbuminuria. What is the nurses most appropriate action?
A) Teach the patient about actions to slow the progression of nephropathy.
B) Ensure that the patient receives a comprehensive assessment of liver function.
C) Determine whether the patient has been using expired insulin.
D) Administer a fluid challenge and have the test repeated.
Ans: A
Feedback:
Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such,
educational interventions addressing this microvascular complication are warranted. Expired insulin
does not cause nephropathy, and the patients liver function is not likely affected. There is no indication
for the use of a fluid challenge.
38. A nurse is assessing a patient who has diabetes for the presence of peripheral neuropathy. The nurse
should question the patient about what sign or symptom that would suggest the possible development of
peripheral neuropathy?
A) Persistently cold feet
B) Pain that does not respond to analgesia
C) Acute pain, unrelieved by rest
D) The presence of a tingling sensation

Ans: D
Feedback:
Although approximately half of patients with diabetic neuropathy do not have symptoms, initial
symptoms may include paresthesias (prickling, tingling, or heightened sensation) and burning sensations
(especially at night). Cold and intense pain are atypical early signs of this complication.
39. A diabetic patient calls the clinic complaining of having a flu bug. The nurse tells him to take his regular
dose of insulin. What else should the nurse tell the patient?
A) Make sure to stick to your normal diet.
B) Try to eat small amounts of carbs, if possible.
C) Ensure that you check your blood glucose every hour.
D) For now, check your urine for ketones every 8 hours.
Ans: B
Feedback:
For prevention of DKA related to illness, the patient should attempt to consume frequent small portions
of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking
fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed
every 3 to 4 hours.
40. A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and
is experiencing HHS. The nurse should identify what components of HHS? Select all that apply.
A) Leukocytosis
B) Glycosuria
C) Dehydration
D) Hypernatremia
E) Hyperglycemia
Ans: B, C, D, E
Feedback:
In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and
electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the
extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity
occur. Leukocytosis does not take place.
Chapter 52: Assessment and Management of Patients with Endocrine

Disorders

1. The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimotos thyroiditis.
When assessing this patient, what sign or symptom would the nurse expect?
A) Fatigue
B) Bulging eyes
C) Palpitations
D) Flushed skin
Ans: A
Feedback:
Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness
or hoarseness, menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes,
palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.
2. A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and
safety, how should the nurse best position the patient?
A) Side-lying (lateral) with one pillow under the head
B) Head of the bed elevated 30 degrees and no pillows placed under the head
C) Semi-Fowlers with the head supported on two pillows
D) Supine, with a small roll supporting the neck
Ans: C
Feedback:
When moving and turning the patient, the nurse carefully supports the patients head and avoids tension
on the sutures. The most comfortable position is the semi-Fowlers position, with the head elevated and
supported by pillows.
3. A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has
been removed. The nurse caring for the patient should prioritize what question when addressing
potential complications?
A) Do you feel any muscle twitches or spasms?
B) Do you feel flushed or sweaty?
C) Are you experiencing any dizziness or lightheadedness?
D) Are you having any pain that seems to be radiating from your bones?
Ans: A
Feedback:
As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet
and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and
pain are atypical signs of the resulting hypocalcemia.
4. The nurse is caring for a patient with a diagnosis of Addisons disease. What sign or symptom is most
closely associated with this health problem?
A) Truncal obesity
B) Hypertension
C) Muscle weakness
D) Moon face
Ans: C
Feedback:
Patients with Addisons disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms,
fatigue, emaciation, dark pigmentation of the skin, and hypotension. Patients with Cushing syndrome
demonstrate truncal obesity, moon face, acne, abdominal striae, and hypertension.
5. The nurse is caring for a patient with Addisons disease who is scheduled for discharge. When teaching
the patient about hormone replacement therapy, the nurse should address what topic?
A) The possibility of precipitous weight gain
B) The need for lifelong steroid replacement

C) The need to match the daily steroid dose to immediate symptoms
D) The importance of monitoring liver function
Ans: B
Feedback:
Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises,
the patient and family members receive explicit education about the rationale for replacement therapy
and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not
common adverse effects.
6. The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would
be the best source of iodine for the body?
A) Eggs
B) Shellfish
C) Table salt
D) Red meat
Ans: C
Feedback:
The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.
7. A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give
the patient who is prescribed long-term corticosteroid therapy?
A) The patients diet should be low protein with ample fat.
B) The patient may experience short-term changes in cognition.
C) The patient is at an increased risk for developing infection.
D) The patient is at a decreased risk for development of thrombophlebitis and thromboembolism.
Ans: C
Feedback:
The patient is at increased risk of infection and masking of signs of infection. The cardiovascular effects
of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. Diet
should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no
longer necessary. Cognitive changes are not common adverse effects.
8. A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected
urinalysis finding?
A) Glucose in the urine
B) Albumin in the urine
C) Highly dilute urine
D) Leukocytes in the urine
Ans: C
Feedback:
Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a
specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or
albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would
indicate a urinary tract infection, if present in the urine.
9. The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test
scheduled for tomorrow. What does the nurse explain that this test will involve?
A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3
hours
B) Administration of dexamethasone IV, followed by an x-ray of the adrenal glands
C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next
morning
D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after

the drug is administered
Ans: C
Feedback:
Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is obtained at 8 AM
the next morning. This test can be performed on an outpatient basis and is the most widely used and
sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing syndrome.
10. You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would
have the highest priority in this care plan?
A) Risk for injury related to weakness
B) Ineffective breathing pattern related to muscle weakness
C) Risk for loneliness related to disturbed body image
D) Autonomic dysreflexia related to neurologic changes
Ans: A
Feedback:
The nursing priority is to decrease the risk of injury by establishing a protective environment. The
patient who is weak may require assistance from the nurse in ambulating to prevent falls or bumping
corners or furniture. The patients breathing will not be affected and autonomic dysreflexia is not a
plausible risk. Loneliness may or may not be an issue for the patient, but safety is a priority.
11. The nurse is performing a shift assessment of a patient with aldosteronism. What assessments should the
nurse include? Select all that apply.
A) Urine output
B) Signs or symptoms of venous thromboembolism
C) Peripheral pulses
D) Blood pressure
E) Skin integrity
Ans: A, D
Feedback:
The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels
consequently affect urine output and BP. The patients peripheral pulses, risk of VTE, and skin integrity
are not typically affected by aldosteronism.
12. The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve
consistency with the bodys natural secretion of cortisol, when would the home care nurse instruct the
patient to take his or her corticosteroids?
A) In the evening between 4 PM and 6 PM
B) Prior to going to sleep at night
C) At noon every day
D) In the morning between 7 AM and 8 AM
Ans: D
Feedback:
In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in
the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active,
produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it
allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally
low, thus minimizing cushingoid effects.
13. A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a
documented history of adrenal insufficiency. Considering the patients history and current symptoms, the
nurse should anticipate that the patient will be instructed to do which of the following?
A) Increase his intake of sodium until the GI symptoms improve.
B) Increase his intake of potassium until the GI symptoms improve.
C) Increase his intake of glucose until the GI symptoms improve.
D) Increase his intake of calcium until the GI symptoms improve.
Ans: A
Feedback:
The patient will need to supplement dietary intake with added salt during episodes of GI losses of fluid
through vomiting and diarrhea to prevent the onset of addisonian crisis. While the patient may
experience the loss of other electrolytes, the major concern is the replacement of lost sodium.
14. The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect
to promote?
A) Complete bed rest
B) Bed rest with bathroom privileges

C) Out of bed (OOB) to the chair twice a day
D) Ambulation and activity as tolerated
Ans: D
Feedback:
Mobility, with walking or use of a rocking chair for those with limited mobility, is encouraged as much
as possible because bones subjected to normal stress give up less calcium. Best rest should be
discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the patient to
getting out of bed only a few times a day also increases calcium excretion and the associated risks.
15. While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the patients
vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect
to see?
A) Hyperthermia and tachypnea
B) Hypertension and heart rate changes
C) Hypotension and hypothermia
D) Hyperthermia and bradycardia
Ans: B
Feedback:
Manipulation of the tumor during surgical excision may cause release of stored epinephrine and
norepinephrine, with marked increases in BP and changes in heart rate. The use of sodium nitroprusside
and alpha-adrenergic blocking agents may be required during and after surgery. While other vital sign
changes may occur related to surgical complications, the most common changes are related to
hypertension and changes in the heart rate.
16. A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that
sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory
finding may be an early indication of parathyroid gland injury or removal?
A) Hyponatremia
B) Hypophosphatemia
C) Hypocalcemia
D) Hypokalemia
Ans: C
Feedback:
Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result
in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the
nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is
known as tetany and must be reported to the physician immediately, because laryngospasm may occur
and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses
to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may
lead to hyperphosphatemia.
17. The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the
patients meal plan?
A) A clear liquid diet, high in nutrients
B) Small, frequent meals, high in protein and calories
C) Three large, bland meals a day
D) A diet high in fiber and plant-sourced fat
Ans: B
Feedback:
A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume
several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet
would not satisfy the patients caloric or hunger needs. A diet rich in fiber and fat should be avoided
because these foods may lead to GI upset or increase peristalsis.
18. A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is
being cared for on the critical care unit. The priority nursing diagnosis for a patient with this condition is
what?
A) Risk for peripheral neurovascular dysfunction
B) Excess fluid volume
C) Hypothermia
D) Ineffective airway clearance
Ans: B
Feedback:
The priority nursing diagnosis for a patient with SIADH is excess fluid volume, as the patient retains
fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing
this syndrome. Temperature imbalances are not associated with SIADH. The patient is not at risk for
neurovascular dysfunction or a compromised airway.
19. A patient with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the
nurse most likely find when assessing this patient?
A) Increased body temperature
B) Jaundice
C) Copious urine output
D) Decreased BP
Ans: D
Feedback:
Decreased BP may occur with hypofunction of the adrenal cortex. Decreased function of the adrenal
cortex does not affect the patients body temperature, urine output, or skin tone.
20. The nurse is assessing a patient diagnosed with Graves disease. What physical characteristics of Graves
disease would the nurse expect to find?
A) Hair loss
B) Moon face
C) Bulging eyes
D) Fatigue
Ans: C
Feedback:
Clinical manifestations of the endocrine disorder Graves disease include exophthalmos (bulging eyes)
and fine tremor in the hands. Graves disease is not associated with hair loss, a moon face, or fatigue.
21. A patient with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone
(ACTH) stimulation test. Administration of ACTH caused a marked increase in cortisol levels. How
should the nurse interpret this finding?
A) The patients pituitary function is compromised.
B) The patients adrenal insufficiency is not treatable.
C) The patient has insufficient hypothalamic function.
D) The patient would benefit from surgery.
Ans: A
Feedback:
An adrenal response to the administration of a stimulating hormone suggests inadequate production of

the stimulating hormone. In this case, ACTH is produced by the pituitary and, consequently, pituitary
hypofunction is suggested. Hypothalamic function is not relevant to the physiology of this problem.
Treatment exists, although surgery is not likely indicated.
22. The physician has ordered a fluid deprivation test for a patient suspected of having diabetes insipidus.
During the test, the nurse should prioritize what assessments?
A) Temperature and oxygen saturation
B) Heart rate and BP
C) Breath sounds and bowel sounds
D) Color, warmth, movement, and sensation of extremities
Ans: B
Feedback:
The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the
body weight is lost. The patients condition needs to be monitored frequently during the test, and the test
is terminated if tachycardia, excessive weight loss, or hypotension develops. Consequently, BP and heart
rate monitoring are priorities over the other listed assessments.
23. A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for
different disorders than other patients. What patient is at a greater risk for the development of
hypothyroidism?
A) A 75-year-old female patient with osteoporosis

B) A 50-year-old male patient who is obese
C) A 45-year-old female patient who used oral contraceptives
D) A 25-year-old male patient who uses recreational drugs
Ans: A
Feedback:
Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in
older women.
24. A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When
administering medications to the patient, the nurse should know that the patients diminished thyroid
function may have what effect?
A) Anaphylaxis
B) Nausea and vomiting
C) Increased risk of drug interactions
D) Prolonged duration of effect
Ans: D
Feedback:
In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are
prolonged. There is no direct increase in the risk of anaphylaxis, nausea, or drug interactions, although
these may potentially result from the prolonged half-life of drugs.
25. A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions
should the nurse include in this patients immediate care? Select all that apply.
A) Administering diuretics to prevent fluid overload
B) Administering beta blockers to reduce heart rate
C) Administering insulin to reduce blood glucose levels
D) Applying interventions to reduce the patients temperature

E) Administering corticosteroids
Ans: B, D
Feedback:
Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and
steroids are not indicated to address the manifestations of this health problem.
26. The nurses assessment of a patient with thyroidectomy suggests tetany and a review of the most recent
blood work corroborate this finding. The nurse should prepare to administer what intervention?
A) Oral calcium chloride and vitamin D
B) IV calcium gluconate
C) STAT levothyroxine
D) Administration of parathyroid hormone (PTH)
Ans: B
Feedback:
When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration
of IV calcium gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D
supplements. PTH and levothyroxine are not used to treat this complication.
27. A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To
prevent adrenal insufficiency, the nurse should ensure that the patient knows to do which of the
following?
A) Take the drug concurrent with levothyroxine (Synthroid).
B) Take each dose of prednisone with a dose of calcium chloride.
C) Gradually replace the prednisone with an OTC alternative.
D) Slowly taper down the dose of prednisone, as ordered.
Ans: D
Feedback:
Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to
prevent steroid-induced adrenal insufficiency. There are no OTC substitutes for prednisone and neither
calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency.
28. Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse
should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which
of the following circumstances?
A) Episodes of high psychosocial stress
B) Periods of dehydration
C) Episodes of physical exertion
D) Administration of a vaccine
Ans: A
Feedback:
During stressful procedures or significant illnesses, additional supplementary therapy with

glucocorticoids is required to prevent addisonian crisis. Physical activity, dehydration and vaccine
administration would not normally be sufficiently demanding such to require glucocorticoids.
29. A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing
diagnosis should the nurse most likely prioritize when planning the patients care?
A) Decisional conflict related to treatment options
B) Spiritual distress related to changes in cognitive function
C) Disturbed body image related to changes in physical appearance
D) Powerlessness related to disease progression
Ans: C
Feedback:
Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body
image. Decisional conflict and powerless may exist, but disturbed body image is more likely to be
present. Cognitive changes take place in patients with Cushing syndrome, but these may or may not
cause spiritual distress.
30. A patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the
following day. To prevent complications, the nurse should anticipate preoperative administration of
which of the following?
A) IV antibiotics
B) Oral antihypertensives
C) Parenteral nutrition
D) IV corticosteroids
Ans: D
Feedback:
IV administration of corticosteroids (methylprednisolone sodium succinate [Solu-Medrol]) may begin on

the evening before surgery and continue during the early postoperative period to prevent adrenal
insufficiency. Antibiotics, antihypertensives, and parenteral nutrition do not prevent adrenal
insufficiency or other common complications of adrenalectomy.
31. A patient is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure
that the patient has been assessed for the most common cause of adrenocortical insufficiency. What is
the most common cause of this health problem?
A) Therapeutic use of corticosteroids
B) Pheochromocytoma
C) Inadequate secretion of ACTH
D) Adrenal tumor
Ans: A
Feedback:
Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiency. The other
options also cause adrenocortical insufficiency, but they are not the most common causes.
32. The nurse providing care for a patient with Cushing syndrome has identified the nursing diagnosis of
risk for injury related to weakness. How should the nurse best reduce this risk?
A) Establish falls prevention measures.
B) Encourage bed rest whenever possible.

C) Encourage the use of assistive devices.
D) Provide constant supervision.
Ans: A
Feedback:
The nurse should take action to prevent the patients risk for falls. Bed rest carries too many harmful
effects, however, and assistive devices may or may not be necessary. Constant supervision is not
normally required or practicable.
33. A patient with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with
the patient to improve the patients nutritional intake. What foods should a patient with Cushing
syndrome eat to optimize health? Select all that apply.
A) Foods high in vitamin D
B) Foods high in calories
C) Foods high in protein
D) Foods high in calcium
E) Foods high in sodium
Ans: A, C, D
Feedback:
Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and
osteoporosis. Referral to a dietitian may assist the patient in selecting appropriate foods that are also low
in sodium and calories.
34. A patient on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks
duration can suppress the adrenal cortex for how long?
A) Up to 4 weeks
B) Up to 3 months
C) Up to 9 months
D) Up to 1 year
Ans: D
Feedback:
Suppression of the adrenal cortex may persist up to 1 year after a course of corticosteroids of only 2
weeks duration.
35. A patient with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal
hypophysectomy. What would be most important for the nurse to monitor before, during, and after
surgery?
A) Blood glucose
B) Assessment of urine for blood
C) Weight
D) Oral temperature
Ans: A
Feedback:
Before, during, and after this surgery, blood glucose monitoring and assessment of stools for blood are
carried out. The patients blood sugar is more likely to be volatile than body weight or temperature.
Hematuria is not a common complication.
36. What should the nurse teach a patient on corticosteroid therapy in order to reduce the patients risk of
adrenal insufficiency?
A) Take the medication late in the day to mimic the bodys natural rhythms.
B) Always have enough medication on hand to avoid running out.
C) Skip up to 2 doses in cases of illness involving nausea.
D) Take up to 1 extra dose per day during times of stress.
Ans: B
Feedback:
The patient and family should be informed that acute adrenal insufficiency and underlying symptoms
will recur if corticosteroid therapy is stopped abruptly without medical supervision. The patient should
be instructed to have an adequate supply of the corticosteroid medication always available to avoid
running out. Doses should not be skipped or added without explicit instructions to do so. Corticosteroids
should normally be taken in the morning to mimic natural rhythms.
37. The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms
should the nurse monitor the patient? Select all that apply.
A) Epistaxis
B) Pallor
C) Rapid respiratory rate
D) Bounding pulse
E) Hypotension
Ans: B, C, E
Feedback:
The patient at risk is monitored for signs and symptoms indicative of addisonian crisis, which can
include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness.
Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.
38. A patient has been assessed for aldosteronism and has recently begun treatment. What are priority areas
for assessment that the nurse should frequently address? Select all that apply.
A) Pupillary response
B) Creatinine and BUN levels
C) Potassium level
D) Peripheral pulses
E) BP
Ans: C, E
Feedback:
Patients with aldosteronism exhibit a profound decline in the serum levels of potassium, and
hypertension is the most prominent and almost universal sign of aldosteronism. Pupillary response,
peripheral pulses, and renal function are not directly affected.
39. A patient who has been taking corticosteroids for several months has been experiencing muscle wasting.
The patient has asked the nurse for suggestions to address this adverse effect. What should the nurse
recommend?
A) Activity limitation to conserve energy
B) Consumption of a high-protein diet
C) Use of OTC vitamin D and calcium supplements
D) Passive range-of-motion exercises
Ans: B
Feedback:
Muscle wasting can be partly addressed through increased protein intake. Passive ROM exercises
maintain flexibility, but do not build muscle mass. Vitamin D and calcium supplements do not decrease
muscle wasting. Activity limitation would exacerbate the problem.
40. The nurse is providing care for an older adult patient whose current medication regimen includes
levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse
effects when administering an IV dose of what medication?
A) A fluoroquinalone antibiotic
B) A loop diuretic
C) A proton pump inhibitor (PPI)
D) A benzodiazepine
Ans: D
Feedback:
Oral thyroid hormones interact with many other medications.Even in small IV doses, hypnotic and
sedative agents may induce profound somnolence, lasting far longer than anticipated and leading to
narcosis (stupor like condition). Furthermore, they are likely to cause respiratory depression, which can
easily be fatal because of decreased respiratory reserve and alveolar hypoventilation. Antibiotics, PPIs
and diuretics do not cause the same risk.

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Chapter 49: Assessment and Management of Patients with Hepatic

A) Alterations in glucose metabolism

B) Retention of bile salts

C) Inadequate production of albumin by hepatocytes

D) Inability of the liver to use vitamin K

2. A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What

B) Assessments for signs and symptoms of venous thromboembolism

C) Daily weights and abdominal girth measurement

D) Blood glucose monitoring q4h

B) Use of standard precautions

C) Consumption of a vitamin-rich diet

D) Annual vitamin K injections

E) Annual vitamin B12 injections

A) Document the presence of normal bile output.

B) Irrigate the drainage system with normal saline as ordered.

C) Aspirate a sample of the drainage for culture.

D) Promptly report this assessment finding to the primary care provider.

A) The patient will obtain measurement of drainage from the T-tube.

B) The patient will exercise three times a week.

C) The patient will take immunosuppressive agents as required.

D) The patient will monitor for signs of liver dysfunction.

A) How many alcoholic drinks do you typically consume in a week?

B) To the best of your knowledge, are your immunizations up to date?

D) Has anyone in your family ever experienced symptoms similar to yours?

A) Infusion of intravenous heparin

C) STAT administration of vitamin K by the intramuscular route

D) IV administration of octreotide (Sandostatin)

Octreotide (Sandostatin)a synthetic analog of the hormone somatostatinis effective in decreasing

A) The hepatitis A vaccine

C) The hepatitis A and B vaccines

D) An immune globulin injection

A) Finish all prescribed courses of antibiotics, regardless of symptom resolution.

B) Adhere to dosing recommendations of OTC analgesics.

C) Ensure that expired medications are disposed of safely.

A) Persistent fever and cognitive changes

B) Abdominal pain and hepatomegaly

C) Peripheral edema unresponsive to diuresis

D) Spontaneous bleeding and jaundice

A) Risk for Infection Related to Immunosuppressant Use

B) Risk for Injury Related to Decreased Hemostasis

C) Risk for Unstable Blood Glucose Related to Impaired Gluconeogenesis

D) Risk for Contamination Related to Accumulation of Ammonia

B) Administer 1 unit of albumin 90 minutes before the procedure as ordered.

A) Two to 3 soft bowel movements daily

B) Significant increase in appetite and food intake

C) Absence of nausea and vomiting

D) Absence of blood or mucus in stool

A) Similar liver size and texture as in younger adults

C) A slightly enlarged liver with palpably hard edges

D) A slightly decreased size of the liver

A) Watery, blood-streaked diarrhea

B) Orange and foamy urine

C) Increased abdominal girth

A) Following proper hand-washing techniques

B) Avoiding chemicals that are toxic to the liver

C) Wearing a condom during sexual contact

D) Limiting alcohol intake

A) Alanine aminotransferase (ALT)

B) C-reactive protein (CRP)