1. Which condition is NOT a known cause of cirrhosis?

A. Obesity

B. Alcohol consumption

C. Blockage of the bile duct

D. Hepatitis C

E. All are known causes of cirrhosis

2-A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below
are complications that can develop from this condition? Select all that apply:*

A. Increase albumin levels

B. Ascites

C. Splenomegaly

D. Fluid volume deficient

E. Esophageal varices

3-Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor
the patient for signs and symptoms of? Select all that apply:*

A. Thrombocytopenia

B. Vision changes

C. Increased PT/INR

D. Leukopenia

4-A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection
below should be avoided with this patient?*

A. Beef tips and broccoli rabe

B. Pasta noodles and bread

C. Cucumber sandwich with a side of grapes

D. Fresh salad with chopped water chestnuts

5-During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to
person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a
flapping motion. What lab result would explain these abnormal assessment findings?*

A. Decreased magnesium level

B. Increased calcium level

C. Increased ammonia level

D. Increased creatinine level

6-You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient’s bilirubin
levels are very high. Based on this, what assessment findings may you expect to find during your head-
to-toe assessment? Select all that apply:*

A. Frothy light-colored urine

B. Dark brown urine

C. Yellowing of the sclera

D. Dark brown stool

E. Jaundice of the skin

F. Bluish mucous membranes

7-A 45 year old male has cirrhosis. The patient reports concern about the development of enlarged
breast tissue. You explain to the patient that this is happening because?*

A. The liver cells are removing too much estrogen from the body which causes the testicles to produce
excessive amounts of estrogen, and this leads to gynecomastia.

B. The liver is producing too much estrogen due to the damage to the liver cells, which causes the level
to increase in the body, and this leads to gynecomastia.

C. The liver cells are failing to recycle estrogen into testosterone, which leads to gynecomastia.

D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the
level to increase in the body, and this leads to gynecomastia.
8-You're providing an in-service to new nurse graduates about esophageal varices in patients with
cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition.
Which activities listed are correct: Select all that apply*

A. Excessive coughing

B. Sleeping on the back

C. Drinking juice

D. Alcohol consumption

E. Straining during a bowel movement

F. Vomiting

9-While providing mouth care to a patient with late-stage cirrhosis, you note a pungent, sweet, musty
smell to the breath. This is known as:*

A. Metallic Hepatico

B. Fetor Hepaticus

C. Hepaticoacidosis

D. Asterixis

10-The physician orders Lactulose 30 mL by mouth per day for a patient with cirrhosis. What findings
below demonstrates the medication is working effectively? Select all that apply:*

A. Decrease albumin levels

B. Decrease in Fetor Hepaticus

C. Patient is stuporous.

D. Decreased ammonia blood level

E. Presence of asterixis
11-Which of the following is NOT a role of the liver?*

A. Removing hormones from the body

B. Producing bile

C. Absorbing water

D. Producing albumin

12-A male client with cirrhosis is complaining of belly pain, itchiness and his breasts are getting larger
and also the abdomen. The client is so upset because of the discomfort and asks the nurse why his
breast and abdomen are getting larger. Which of the following is the appropriate nursing response?

“Your liver is not destroying estrogen hormones that all men produce”

“It’s probably because you have been less physically active”

“It’s part of the swelling your body is experiencing”

“How much of a difference have you noticed

13-Mr. Gonzales develops hepatic encephalopathy. Which clinical manifestation is most common with
this condition?

Increased urine output

Hypotensio

Decreased tendon reflex

Altered level of consciousness

14-A male client with a history of cirrhosis and alcoholism is admitted with severe dyspnea resulted to
ascites. The nurse should be aware that the ascites is most likely the result of increased…

Interstitial osmotic pressure

Pressure in the portal vein

Production of serum albumin

Secretion of bile salts

15-A nurse is completing an assessment to a client with cirrhosis. Which of the following nursing
assessment is important to notify the physician?

Ascites and serum albumin of 3.2 g/dl

Hematocrit of 37% and hemoglobin of 12g/dl

Slurred speech

Expanding ecchymosis

16-A Sengstaken-Blakemore tube is inserted in the effort to stop the bleeding esophageal varices in a
patient with complicated liver cirrhosis. Upon insertion of the tube, the client complains of difficulty of
breathing. The first action of the nurse is to:

Encourage him to take deep breath

Deflate the esophageal balloon

Notify the MD

Monitor VS
17-Mr. Gonzales was admitted to the hospital with ascites and jaundice. To rule out cirrhosis of the liver:
The biopsy of Mr. Gonzales confirms the diagnosis of cirrhosis. Mr. Gonzales is at increased risk for
excessive bleeding primarily because of:

Varix formation

Impaired clotting mechanism

Trauma of invasive procedure

Inadequate nutrition

18-The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client
has deficient vitamin K absorption caused by this hepatic disease?

Ascites and orthopnea

Purpura and petechiae

Gynecomastia and testicular atrophy

Dyspnea and fatigue

19-A man is admitted to the nursing care unit with a diagnosis of cirrhosis. He has a long history of
alcohol dependence. During the late evening following his admission, he becomes increasingly
disoriented and agitated. Which of the following would the client be least likely to experience?

Increased blood pressure and heart rate.

Illusions.

Delusions of grandeur.

Diaphoresis and tremors

20-Which of the following findings would strongly indicate the possibility of cirrhosis?

Dry skin

Peripheral edem

Hepatomegaly

Pruritus

21-A patient reports frequent heartburn twice a week for the past 4 months. What other symptoms
reported by the patient may indicate the patient has GERD? SELECT-ALL-THAT-APPLY:*

A. Bitter taste in mouth

B. Dry cough

C. Melena

D. Difficulty swallowing

E. Smooth, red tongue

F. Murphy's Sign

22-Your patient, who is presenting with signs and symptoms of GERD, is scheduled to have a test that
assesses the function of the esophagus' ability to squeeze food down into the stomach and the closer of
the lower esophageal sphincter. The patient asks you, "What is the name of the test I'm having later
today?" You tell the patient the name of the test is:*

A. Lower Esophageal Gastrointestinal Series

B. Transesophageal echocardiogram

C. Esophageal manometry

D. Esophageal pH monitoring
23-After dinner time, during hourly rounding, a patient awakes to report they feel like "food is coming
up" in the back of their throat and that there is a bitter taste in their mouth. What nursing intervention
will you perform next?*

A. Perform deep suctioning

B. Assist the patient into the Semi-Fowler's position

C. Keep the patient NPO

D. Instruct the patient to avoid milk products

24-After providing education to a patient with GERD. You ask the patient to list 4 things they can do to
prevent or alleviate signs and symptoms of GERD. Which statement is INCORRECT?*

A. "It is best to try to consume small meals throughout the day than eat 3 large ones."

B. "I'm disappointed that I will have to limit my intake of peppermint and spearmint because I love
eating those types of hard candies."

C. "It is important I avoid eating right before bedtime."

D. "I will try to lie down after eating a meal to help decrease pressure on the lower esophageal
sphincter."

25-A patient is taking Bethanechol "Urecholine" for treatment of GERD. This is known as what type of
drug?*

A. Proton-pump inhibitor

B. Histamine receptor blocker

C. Prokinetic

D. Mucosal Healing Agent

26-The male client tells the nurse he has been experiencing "heartburn" at night that awakens him.
Which assessment question should the nurse ask?

1. How much weight have you gained recently?

2. What have you done to alleviate the heartburn?

3. Do you consume many milk and dairy products?

4. Have you been around anyone with a stomach virus?

27-The nurse caring for a client diagnosed with GERD writes the client problem of "behavior
modification." Which intervention should be included for this problem?

1. Teach the client to sleep with a foam wedge under the head.

2. Encourage the client to decrease the amount of smoking.

3. Instruct the client to take over the counter medication for relief of pain.

4. Discuss the need to attend Alcoholics Anonymous to quit drinking.

28-The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction.
Which dietary modifications should be included in the plan of care?

1. Allow any of the clients favorite foods as long as the amount is limited.

2. Have the client perform eructation exercises several times a day.

3. Eat four to six small meals a day and limit fluids during mealtimes.

4. Encourage the client to consume a glass of red wine with one meal a day.

29-Which statement made by the client indicates to the nurse the client may be experiencing GERD?

1. My chest hurts when I walk up the stairs in my home.

2. I take antacid tablets with me wherever I go

3. My spouse tells me I snore very loudly at night

4. I drink six to seven soft drinks every day.

30=The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and
symptoms would indicate GERD?

1. Pyrosis, water brash, and flatulence.

2. Weight loss, dysarthria, and diarrhea.

3. Decreased abdominal fat, proteinuria, and constipation.

4. Midepigastric pain, positive H. Pylori test, and melena.

31-Which disease is the client diagnosed with GERD at greater risk for developing?

1. Hiatal hernia

2. Gastroenteritis

3. Esophageal cancer

4. Gastric cancer