NCM 116 Set A

1. Majority of blood supply to the liver, which is rich in nutrients from gastrointestinal tract,
comes from the:

A.hepatic artery C.portal artery

B.hepatic vien D.portal vien

Answer: D

Rationale: Portal Vein is a blood vessel that carries blood containing nutrients and oxygen from
the digestive tract and spleen into the liver.

2. The liver plays a major role in glucose metabolism by:

A.producing ketone bodies

B.synthesizing albumin

C.participating in gluconeogenesis

D.doing all of the above

Answer: C

Rationale: The liver has a major role in the control of glucose homeostasis by controlling various
pathways of glucose metabolism, including glycogenesis, glycogenolysis, glycolysis and
gluconeogenesis.

3. The liver synthesizes prothrombin only if there is enough:

A.vitamin A C.vitamin D

B.vitamin B12 D.vitamin K

Answer: D

Rationale: The prothrombin is a plasma protein synthesized in the liver. Vitamin K is essential
for the synthesis of prothrombin.

4. The substance necessary for the manufacture of bile salts by hepatocytes is:

A.albumin C.cholesterol

B.bilirubin D.vitamin D
Answer: C

Rationale: One of cholesterol's many functions in the body is to act as a precursor to vitamin D.
Since cholesterol is a precursor to vitamin D, inhibiting the synthesis of cholesterol will also
inhibit the synthesis of vitamin D, which helps in calcium metabolism and bone health.
Cholesterol is also needed for the synthesis of various hormones, including the sex hormones.

5. The main function of bile salts is:

A.albumin synthesis

B.fat emulsification in the intestine

C.lipid manufacture for the transport of protein

D.urea synthesis from ammonia

Answer: B

Rationale: Bile juice is produced by the liver and its main function is emulsification of fat.
Emulsification of fat is the breakdown of large fat globules into smaller, uniformly distributed
particles. It is accomplished mainly by bile salts in the small intestine. Emulsification is the first
preparation of fat for chemical digestion by specific enzymes.

6. Hepatocellular dysfunction results in all of the following except:

A.decreased serum albumin

B.elevated serum bilirubin

C.increased blood ammonia levels

D.increas levels of urea

Answer: D

Rationale:hepatic encephalopathy

central nervous system dysfunction resulting from liver disease; frequently associated with
elevated ammonia levels that produce changes in mental status, altered level of consciousness,
and coma.

7. Jaundice becomes evident when serum bilirubin levels exceed:

A.0.5mg/dL C.1.5mg/dL

B.1.0mg/dL D.2.5mg/dL
Answer: D

Rationale: Normal bilirubin level is 0.1 - 0.2 mg / 100ml of blood. When bilirubin elevation is
slightly high i.e., upto 2mg / 100ml of blood, then this results jaundice.

8. The liver converts ammonia to urea. What level of ammonia would suggest liver failure?

A.40 ug/dL C.200 ug/dL

B.100 mg/dL D.300 mg/dL

Answer: D

Rationale: Your liver may not be working properly if you have high levels of ammonia in your
blood. Ammonia is a chemical made by bacteria in your intestines and your body's cells while
you process protein. Your body treats ammonia as a waste product, and gets rid of it through the
liver. It can be added to other chemicals to form an amino acid called glutamine. It can also be
used to form a chemical compound called urea. Your bloodstream moves the urea to your
kidneys, where it is eliminated in your urine.

9. The most common cause of parenchymal cell damage and hepatocellular dysfunction is:

A.infection agents C.metabolic disorder

B.malnutrition D.toxins

Answer: B

Rationale: Liver disease, especially alcohol related, is increasingly common and is often
accompanied by malnutrition as a result of reduced intake, absorption, processing and storage of
nutrients. An increase or alteration in metabolic demands also occurs and some patients have
high.

10. Negative sodium balance is important for a patient with ascites would be:

A.one-forth cup of peanut butter

B.one cup of powdered milk

C.one frank further

D.two slices of cold nuts

Answer: B

Rationale: It is usually posited that in order to avoid fluid retention, oral sodium intake must be
significantly reduced in order to achieve a negative sodium balance. Salt restriction would
further decrease fluid accumulation by lowering portal pressure through vascular volume
depletion.

11. The nurse expect that the diuretic of choice for patient with ascites would be:

A.Aldactone C.Diamox

B.ammonium chloride D.Lasix

Answer: A

Rationale: Diuretic resistant ascites—ascites that is refractory to dietary sodium restriction and
intensive diuretic treatment (spironolactone 400 mg/day and frusemide 160 mg/day for at least
one week, and a salt restricted diet of less than 90 mmol/day (5.2 g of salt)/day).

12. An indicator of portable esophageal varices is:

A.hematemesis C.melena

B.A positive guaic test D..all of the above

Answer: D

Rationale:— An indicator of portable esophageal varices are hematemesis, A positive guaic test
and melena. They form due to portal hypertension, which commonly is a result of cirrhosis,
resistance to portal blood flow, and increased portal venous.

13. The mortality rate from first bleeding episode for the esophageal varices is about:

A.10% to 15% C.30% to 50%

B.15% to 25% D.80% or higher

Answer: C

Rationale:s. Mortality of the first bleeding episode is high and ranges between 30% and 50%
within 6 weeks.

14. Bleeding esophageal varices result in a decrease in:

A.nitrogen load from bleeding C.serum ammonia

B.renal perfusion D.all of the above

Answer: B

Rationale: This happens due to portal hypertension (most commonly a result of cirrhosis),
resistance to portal blood flow, and increased portal venous.
15. The initial model of therapy to treat variceal hemorrhage that decreases portal pressure and
produces constriction is:

A.Corgard C.Petressin

B.Isordil D.Somatostatin

Answer: C

Rationale:NSBB reduce portal pressure and decrease the risk of the first bleed from 25% to 15%
in primary prophylaxis.

16. A person who consumes contaminated shellfish would probably develop:

A.hepatitis B C.hepatitis D

B.hepatitis C D.hepatitis E

Answer: D

Rationale: A person who consumes contaminated shellfish would probably develop: hepatitis E.
The hepatitis virus that is transmitted via the fecal-oral route is: hepatitis A virus. Immune serum
globulin provides passive immunity against type A hepatitis in those not vaccinated if it is
administered within 2 weeks of exposure.

17. The hepatitis virus that is transmitted via the fecal-oral route is:

A.hepatitis A virus C.hepatitis C virus

B.hepatitis B virus D.hepatitis D virus

Answer: A

Rationale: Hepatitis A virus (HAV) is transmitted through the oral–fecal route, and antibody to
HAV IgM appears during the acute phase of hepatitis A.

18. Immune serum globulin provides passive immunity against type A hepatitis in those not
vaccinated if it is administered within 2 weeks of exposure. Immunity is effective for about:

A 1 month C.3 months

B.2 months D.4 months

Answer: B

Rationale:Immunoglobulin provides temporary (1-2 months) passive immunity and is effective

for preventing hepatitis A if given within 2 weeks of exposure. It may not prevent an infection in
all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine
is only used for preexposure prophylaxis.

19. Choose the correct statement about hepatitis B vaccine

A.All person ar risk should receive active immunization

B.Evidence suggest that the human immunodeficiency virus (HIV) may be harboured in the
vaccine

C.Booster doses are recommended for 5 years

D.One dose in the dorsogluteal muscle is recommended

Answer: A

Rationale: Hepatitis B vaccine can prevent hepatitis B.Hepatitis B is a liver disease that can
cause mild illness lasting a few weeks, or it can lead to a serious, lifelong illness.

20. Indication for postexposure vaccination with hepatitis B immune globulin include:

A.accidentall exposure to HbAg positive blood

B.perinatal exposure

C.sexual contact with those who are positive for HbAg

D.all of the above exposure

Answer: D

Rationale:HBV is transmitted through activities that involve percutaneous. The recommended

treatment for exposure to hepatitis B in unvaccinated individuals is to receive both HBIG and the
hepatitis B vaccine, which would provide temporary passive immunity and promote active
immunity.

21. This hepatitis virus caused by contaminated needles shared by drugs users is expected to
increase fourfold by 2015. This type of hepatitis, which is also most common cause for liver
transplant

A. Hepatitis A

B. Hepatitis B

C. Hepatitis C

D. Hepatitis D
Answer: C

Rationale: Hepatitis C is a liver infection that can lead to serious liver damage. It's caused by the
hepatitis C virus.

22. The chemical most commonly implicated in toxic hepatitis is

A. chloroform

B. gold compounds

C. phosphorus

D. All of the above hepatotoxin

Answer D.

Rationale:The chemical most commonly implicated in toxic hepatitis are chloroform, gold
compounds, phosphorus. Toxic liver disease is damage to your liver. It's also called
hepatotoxicity or toxic hepatitis. It can cause serious symptoms or liver damage if you don't get
help. Medications, herbal supplements, chemicals, solvents, and alcohol are all possible causes
of hepatotoxicity.

23. Acetaminophen found in over the counter (OTC) drugs is the leading cause of acute liver
failure

A. Advil

B. Aleve

C. Motrin

D. Tylenol

Answer: D

24. Fulminant hepatic failure may progress to hepatic encephalopathy about how many weeks
after disease onset?

A. 2 weeks

B. 4 weeks

C. 6 weeks

D. 8 weeks

Answer: 8 weeks
Rationale: Fulminant hepatic failure (FHF) has traditionally been defined as the presence of
acute liver failure including the development of hepatic encephalopathy within 8 weeks after the
onset of jaundice in a patient without a prior history of liver disease

25. Major causative factor an etiology of cirrchosis

A. Acute viral hepatitis

B. Chronic alcoholism

C. Chronic biliary obstruction

D. Infection ( cholangitis)

Answer: A

26.. Late symptoms of hepatic cirrhosis include all of the following except edema,
hypoalbuminemia, hypokalemia

A. Edema

B. Hepoalbuminemia

C. Hypokalemia

D. Hyponatremia

Answer: D

Rationale: Late symptoms of hepatic cirrhosis include all of the following except edema,
hypoalbuminemia, hypokalemia

27. Cirrhosis results in shunting of portal system blood into collateral blood vessels in the
gastrointestinal tract. The most common site is:

A. The esophagus

B. The lower rectum

C. The Stomach

D. A combination of all of the above

Answer: D

Rationale: The most common site are the esophagus, the lower rectum, the stomach.
28. Signs of advanced liver disease include: ascites, jaundice, portal hypertension

A. Ascites

B. Jaundice

C. Portal hyoertension

D. All of the above

Answer: D

Rationale: Signs of advanced liver disease include: ascites, jaundice, portal hypertension

29. The most common single cause of death in patients with cirrhosis is:

A. Congested heart failure

B. Hepatic encephalopathy

C. Hypovolemic shock

D. Ruptured esophageal varices

Answer: D

30. Hepatic lobectomy for cancer can be successful when the primary site is localized. Because
of the regenerative capacity of the liver, a surgeon can remove up to what percentage of liver
tissue?

A. 25%

B. 50%

C. 75%

D. 90%

Answer: D

Situatuon: Veronica is scheduled for a liver biopsy. The staff nurse assigned to care for
venronica is to accompany her to the treatment room.

31. Before a liver biopsy, the nurse should check to see that:

A. a compatible donor blood is available

B. coagulation studies have been completed

C. vital signs have been assessed

D. All of the above been done

Answer: D

Rationale:Before a liver biopsy, the nurse should check to see that: a compatible donor blood is
available, coagulation studies have been completed, vital signs have been assessed.

32. The nurse begins preparing for the biopsy assisting the client into the correct position which
is

a. A jacknife with her entire back exposed

b. recumbent with the right upper abdomen exposed

c. lying on the right side with the left upper thoracic area exposed

d. supine with the left lateral chest wall exposed

Answer: B) recumbent with the RUQ exposed

Rationale:

33. The nurse knows that the biopsy needle will be inserted into the liver between the: sixth
and seventh ribs

A. Third and fourth ribs

B. Fourth and fifth ribs

C. Sixth and seventh ribs

D. Eight and ninth ribs

Answer: C

Rationale: Percutaneous liver biopsy procedure uses needle between 6th and 7th intercoastal
space on the right side to obtain specimen or hepatic tissue.

34. Immediately before needle insertion, Veronica needs to be instructed to

a. breathe slowly and deply so that the rib cage expansion will be minimized during needle
insertion
b. inhale and exhale deeply and then hold her breath at the end of expiration until the needle is
inserted

c. pant deeply and continue panting during needle insertion so pain perception will be minimized

d. take a deep inspiration and not breathe for 30 seconds so the needle insertion site can be
determined then resume normal breathing for the rest of the procedure

Answer: (B) inhale and exhale deeply and hold her breath at the end of expiration until the
needle is inserted

Rationale:

35. After the biopsy the nurse assists the Veronica to

a. high Fowler's position in which the client can effectively deep breathe and cough

b. ambulate with splinting her incision

c. assume the Trendelenburg position to prevent post biopsy shock

d. the right side lying position with a pillow placed under the right costal margin

Answer: (D) right side lying position with a pillow placed under the right costal margin

Rationale: 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.

Situation: Wendy scheduled for a paracentesis because of ascites formation subsequent to

cirrhosis of the liver

36. Before the procedure the nurse obtain several drainage bottle. She knows that tge maximum
amount of fluid to be aspriated at one time is:

A. 1L

B. 2L

C. 3L

D. 4L

Answer: D
Rationale: Therapeutic paracentesis refers to the removal or maximum amount of fluid of 4L to
reduce intra-abdominal pressure and relieve the associated dyspnea, abdominal pain and early
saliety.

37. The nurse helps wendy to assume the proper position for a paracentesis which is:

A. Recumbent so that the fluid will pool to the lower abdomen

B. Ambulate while splinting her incision

C. Semi fowlers to avoid shock and provide the most comfort

D. Upright with her feet resting on a support so that the puncture site will be readily visible

Answer: D

Rationale: Client who have ascites are typically more comfortable sitting up (Upright with her
feet resting on a support so that the puncture site will be readily visible).

38. After a paracentesis a client should be observed for signs of vascular collapse which include
the following except:

a. bradycardia

b. hypotension

c. oliguria

d. pallor

Answer: A) bradycardia

Rationale: Fluid Volume deficit can occur due to increased fluid excretion by the kidneys or
excessive diaphoresis which leads to tachychardia not bradychardia.

Situation: Nathan a 50 year old physically disabled veteran has lived alone for 30 years. He has
maintained his independence despite chronic back pain resulting from a war injury. He has a
long history of depression and limited food intake. He drinks 6 to 10 bottles of beer daily. He has
recently admitted to a veterans hospital with diagnosis of alcoholic or nutritional cirrchosis. He
was asymptomatic for ascites.

39. On assessment the nurse notes early clinical manifestation of alcoholic or nutritional cirrhosis
which include all of the folowing except:

A. A pain caused by liver enlargement

B. A sharp edge to the periphery of the liver

C. A liver decreased in size and nodular

D. Firm liver

Answer: C

40. An abnormal laboratory finding for Nathan is a:

A. Blood ammonia level of 35 mg/dL

B. Serum albumin concentration of 4.0 g/dL

C. Total serum bilirubin level of 0.9 mg/dL

D. Total serum bilirubin level of 5.5 mg/dL

Answer: D

41. Nathan is 5 ft 8 in tall and weighs 154lb. The physician recommends 50cal\kg for weight
gain. Nathans daily caloric intake would approximately:

A. 2,200 calories

B. 2,800 calories

C. 3,500 calories

D. 3,800 calories

Answer : A

Rationale: It takes even more energy to build and store muscle mass through muscle protein
synthesis (MPS).

42. A recommended daily protein intake for Nathan to gain weight is:

A. 31 to 44 g

B. 41 to 54 g

C. 51 to 64 g

D. 61 to 74 g

Answer: C
Rationale: Nutrilite Soy Protein Drink provides your body with 8g protein and 9 essential amino
acids.

43. The physician recommends a sodium-restricted diet. The nurse expects the suggested sodium
intake to be approximately:

A. 250 to 500 mg/24 h

B. 500 to 1000 mg/24 h

C. 2000 to 2500 mg/24 h

D. 3000 to 3500 mg/24 h

Answer: C

Rationale: shows that restricting sodium may help control or improve certain medical conditions.

Situation: Denise a 54 year old mother of three is scheduled for a liver transplantation
subsequent to an extensive hepatic malignancy with multifocal tumors greater than 8 cm in
diameter.

44. Denise is hopeful that her surgery will be successful. She is aware however that her chance
of survival at 5 years about:

A. 10%

B. 30%

C. 50%

D. 70%

Answer: D

Rationale: That means that for every 100 people who receive a liver transplant for any reason,
about 75 will live for five years and 30 will die within five years.

45. Denise knows that the successful outcome to transplantation will be compromised by:

A. fluid and electrolyte disturbances

B. malnutrition

C. immunosuppressive therapy

D. all of the above

Answer: C

Rationale: Having a weakened immune system also means that you pick up infections more
easily.

46. The nurse is aware that the postoperatively the most common complication after liver
transplant is:

A. bleeding

B. hypotension

C. infection

D. portal hypertension

Answer: D

Rationale: Portal vein stricture can manifest shortly after liver transplantation because of the
increased production.

47. The nurse knows that a patient receiving cyclosporine to prevent rejection of transplanted
liver may develop a drug side effect of:

A. nephrotoxicity

B. septicaemia

C. thrombocytopenia

D. all of the above reactions

Answer: A

Rationale: This irreversible form is associated with histologic changes in the kidney that may
ultimately necessitate renal support through dialysis or transplantation.

48. Bile is stored in the:

A. cystic duct

B. duodenum

C. gallbladder

D. common bile duct

Answer: C
Rationale: The pancreas makes enzymes that help digest proteins, fats, and carbs. It also makes a
substance that neutralizes stomach acid.

49. A patient is diagnosed with gallstones in the bile ducts. The nurse knows to review the results
of blood work for:

A. serum ammonia concentration of 90 mg/dl

B. serum albumin concentration 4.0 mg/dl

C. serum bilirubin level greater than 1.0 mg/dl

D. serum globulin concentration of 2.0 g/dl

Answer: C

Rationale: It occurs when bilirubin production exceeds the liver's excretory capacity. This may
occur because. too much bilirubin is being produced, hepatocytes are injured and cannot
metabolize or excrete bilirubin.

50. The major stimulus for increase bicarbonate secretion from pancreas is:

A. amylase

B. lipase

C. secretin

D. trypsin

Answer: C

Rationale: Secretin is produced in the duodenal mucosa and acts on the pancreas where it
stimulates the release of bicarbonate and water.

51. An action not associated with insulin is the:

A. conversion of glycogen to glucose in the liver

B. lowering of blood glucose

C. promotion of fat storage

D. synthesis of proteins

Answer: A
Rationale: Glycogen stored in the liver and muscles, is converted first to glucose-1- phosphate
and then into glucose-6-phosphate. Two hormones which control glycogenolysis are a peptide,
glucagon from the pancreas and epinephrine from the adrenal glands.

52. The nurse knows that a patient with low blood sugar would have a blood glucose level of:

A. 55 to 75mg/dl

B. 80 to 120mg/dl

C. 130 to 150mg/dl

D. 160 to 180mg/dl

Answer: A

Rationale: metabolism and guides interventions to achieve optimal glucose control within the
body. All nurses should be familiar with the importance of blood glucose monitoring and the
procedure to carry out testing safely and effectively.

53. A patient with calculi in the gallbladder is said to have:

A. cholecystitis

B. cholelithiasis

C. choledocholithiasis

D. choledochotomy

Answer: B

Rationale: The size and number of gallstones varies in cholelithiasis; the gallbladder can form
many small stones or one large stone. Gallstones may migrate to the bile duct after
cholecystectomy or, particularly in the case of brown pigment stones.

54. Statistics shows that there is a greater incidence of gallbladder disease for women who are:

A. multiparous

B. obese

C. older than 40 years of age

D. characterized by all of the above

Answer: D
Rationale: = Researchers have found that people who have obesity may have higher levels of
cholesterol in their bile, which can cause gallstones. People who have obesity may also have
large gallbladders that do not work well.

55. The obstruction of bile flow due to cholelitiasis can infere with the absorption of:

A. vitamin A

B. vitamin B6

C. vitamin B12

D. vitamin C

Answer: A

Rationale: Biliary obstruction commonly refers to blockage of the bile duct system leading to
impaired bile flow from the liver.

56. Clinical manifestation of common bile duct obstruction include all of the following except:

A. amber colored urine

B. clay colored feces

C. pruritus

D. jaundice

Answer: A

Rationale: Fluids dilute the yellow pigments in urine, so the more you drink, the clearer your
urine looks. When you drink less, the color becomes more concentrated. Severe dehydration can
produce urine the color of amber.

57. The diagnostic procedure of choice for cholelitiasis is:

A. x-ray

B. oral cholecystography

C. cholecystography

D. ultrasound

Answer: D
Rationale: This test is the one most commonly used to look for signs of gallstones. Abdominal
ultrasound involves moving a device (transducer) back and forth across your stomach area

58. Pharmacologic therapy is frequently use to dissolve small gallstones. It takes about how
many months of medication with UDCA or CDCA for stones to dissolve?

A. 1 to 2 months

B. 3 to 5 months

C. 6 to 8 months

D. 6 to 12 months

Answer: D

Rationale: aims to span the timeframe of potential proliferation. From: Comprehensive

Dermatologic Drug Therapy.

59. Chronic pancreatitis commonly described as auto digestion of the pancreas is often not
detected until what percentage of the exocrine and endocrine tissue is destroyed?

A. 10% to 25%

B. 30% to 50%

C. 60% to 75%

D. 80%-90%

Answer: D

Rationale: The operation has application to patients with pain or complications of chronic
pancreatitis with dilated ducts in the body and tail of the pancreas who have small strictured
ducts and/or small pseudocysts or ducts impacted with calculi in a markedly enlarged fibrotic
pancreatic head.

60. Mild acute pancreatitis is characterized by:

A. edema and inflammation

B. pleural effusion

C. sepsis

D. disseminated intravascular coagulopathy

Answer: A
Rationale: Gallstones are a common cause of pancreatitis. Gallstones, produced in the
gallbladder, can block the bile duct, stopping pancreatic enzymes from traveling to the small
intestine and forcing them back into the pancreas.

61. A major symptoms of pancreatitis that brings the patient to medical cure is:

A. severe abdominal pain

B. fever

C. jaundice

D. mental agitation

Answer: A

Rationale: There is marked pancreatic necrosis along with vascular inflammation and
thrombosis. The presenting symptoms of acute pancreatitis are typically abdominal pain and
elevated pancreatic enzymes, which are evident in blood and urine testing because of an
inflammatory process in the pancreas.

62. The nurse should assess for an important early indicator of acute pancreatitis which is a
prolonged and elevated level of:

A. serum calcium

B. serum lipase

C. serum bilirubin

D. serum amylase

Answer: B

Rationale: Serum lipase is now the preferred test due to its improved sensitivity, particularly in
alcohol-induced pancreatitis. Its prolonged elevation creates a wider diagnostic window than
amylase. Neither enzyme is useful in monitoring or predicting the severity of an episode of
pancreatitis in adults.

63. Nursing measure for pain relief for acute pancreatitis include:

A. encouraging bed rest to decrease the metabolic rate

B. teaching the patient about the correlation between alcohol intake and pain

C. withholding oral feedings to limit the release of secretin

D. all of the above

Answer: D

Rationale: The patient is maintained on bed rest to decrease metabolic rate and reduce the
secretion of pancreatic and gastric enzymes. Alcohol is one of the causes of pain in pancreatitis.
Oral feedings are withheld to decrease the secretion of secretin.

64. The risk for pancreatic cancer is directly proportional to:

A. age

B. dietary intake

C. cigarette smoking

D. presence f diabetes mellitus

Answer: A

Rationale: Incidence of pancreatic cancer increases with age, peaking in the seventh and eighth
decades for both men and women. It is very rare before 45 years, and most patients present in or
beyond the sixth decade of life. Cigarette smoking, exposure to industrial chemicals or toxins in
the environment, and a diet high in fat, meat, or both are associated with pancreatic cancer,
although their roles are not completely clear. Diabetes mellitus, chronic pancreatitis, and
hereditary pancreatitis are also associated with pancreatic cancer.

65. With the pancreatic carcinoma insulin deficiency is suspected when the patient evidences:

A. an abnormal glucose tolerance

B. glucosuria

C. hyperglycemia

D. all of the above

Answer: D

Rationale: An important sign, if present, is the onset of symptoms of insulin deficiency:

glucosuria, hyperglycemia, and abnormal glucose tolerance. Therefore, diabetes may be an early
sign of carcinoma of the pancreas.

66. Clinical manifestations associated with a tumor of the head of the pancreas include?

A. clay-colored stools

B. dark urine
C. jaundice

D. all of the above

Answer: D

Rationale: : Signs and symptoms of pancreatic cancer often don't occur until the disease is
advanced. They may include: Abdominal pain that radiates to your back, Loss of appetite or
unintended weight loss, Yellowing of your skin and the whites of your eyes (jaundice), Light-
colored stools, Dark-colored urine, Itchy skin, New diagnosis of diabetes or existing diabetes
that's becoming more difficult to control, Blood clots, Fatigue.68. Zollinger-Ellison tumors are
associated with hypersecretion of:

67. A nurse should monitor blood glucose levels for a patient who is diagnosed as having
hyperinsulinism value inadequate to sustain normal brain function is:

A. 30mg\dL

B. 50mg\dL

C. 70mg\dL

D. 90mg\dL

Answer: A

Rationale: Hyperinsulinism is caused by overproduction of insulin by the pancreatic islets.

Occasionally, tumors of nonpancreatic origin produce an insulinlike material that can cause
severe hypoglycemia and may be responsible for seizures coinciding with blood glucose levels
that are too low to sustain normal brain function (i.e., lower than 30 mg/dL [1.6 mmol/L]).

68. Zollinger-Ellison tumors are associated with hypersecretion of:

A. aldosterone

B. gastric acid

C. insulin

D. vasopressin

Answer: B
Rationale: ZES is caused by gastrinoma which causes trophic effects of gastrin hypersecreting
gastric acid. It can cause severe abdominal pain from multiple ulcers in the esophagus, stomach,
and duodenum, diarrhea, and heartburn. PPIs have been the main therapy to control the
symptoms.

Situation: Brenda a 33 year old obese mother of four, is diagnosed as having acute gallbladder
inflammation. She is 5 ft 4 in tall and weighs 190 lb. The physician decides to delay surgical
intervention until Brenda’s acute symptoms subside.

69. Brenda’s initial course of treatment would probably consist of:

A. analgesic and antibiotics suctioning

B. intravenous fluids

C. nasogastric

D. all of the above

Answer: D

Rationale: Analgesics and antibiotics are primary medications for a patient with cholecystitis,
and nasogastric suctioning is performed to prevent gastric sludge.

Options A, B, C: All of the options are part of the treatment for cholecystitis.

70. After her acute attack, Brenda was limited t law fat liquids. As foods are added to her diet she
needs to know that she should avoid:

A. cooked fruits

B. eggs and cheese

C. lean meats

D. rice and topica

Answer: B

Rationale: Eggs and cheese are rich in cholesterol which is contraindicated in patients with
cholecystitis.

Option A: Cooked fruits are rich in fiber and good for the digestive health.
Option C: Lean meats are low in fat content.

Option D: Rice and tapioca are rich in carbohydrates.

71. Brenda is being medicated with chenodeoxycholic acid. The nurse needs to tell Brenda that
the drug may not be effective if it is taken in conjunctive with:
A. dietary cholesterol

B. estrogens

C. oral contraceptive

D. any of the above

Because Brenda’s symptoms continue to recur, She is scheduled for gallbladder surgery

72. Brenda has signed a consent form for removal of her gallbladder and ligation of the cystic
duct and artery. She is scheduled to undergo a:

A. cholecystectomy

B. cholecystostomy

C. choledochoatomy

D. choledocholithomy

73. Postoperative nursing observation includes assessing for:

A. indicators of infection

B. leakage of bile into the peritoneal cavity

C. obstruction of bile drainage

D. all of the above

74. Brenda needs to know that the fat restriction is usually lifted after the biliary ducts dilate to
accommodate bile once held by the gallbladder. This takes about:

A. 1 week

B. 2 to 3 weeks

C. 4 to 6 weeks

D. 2 months

75. Glucose intolerance increases with age. The incidence in those older than 65 years is:
A. 20%

B. 50%

C. 65%

D. 80%

76. A client diagnosed with IDDM becomes irritable and confused: the skin is cool and clammy
and the pulse rate is. The first action of the nurse would be to:

A. give a half-cup of orange juice

B. check the serum glucose

C. administer regular insulin

D. call the physician

77. A client with IDDM is recovering from DKA. Information of the serum level of the
following substance will be very important to the nurse:

A. sodium

B. calcium

C. potassium

D. magnesium

78. A nurse assumes responsibility for the care of the client at 7A.M. NPH insulin is ordered for
7:30A.M. Before giving the inslin, the nurse checks to see if the client will eat that day and for
the:

A. signs and symptoms of hypoglycaemia

B. previous sites of injection

C. serum glucagons level

D. serum glucose level

79. A client with IDDM has just been admitted to the ER after hitting a telephone pole with her
car. Bystanders said she acted as if she has been drinking. Her temperature is 37.4 degrees
Celsius, pulse 80, resp. 44 and deep. She complained of headache and acted confused. A fruity
odor was noted on her breath. Her ABG report read=pH= 7.32, Pco2=36, and bicarbonate=18.
The nurse prepared for the treatment of:

A. metabolic acidosis

B. metabolic alkalosis

C. respiratory acidosis

D. respiratory alkalosis

80. Additional teaming to a newly diagnosed diabetic client related to the effects of regular
insulin is necessary when the client asks, “if I take my regular insulin at 8 A.M, when might I
experience signs of low blood sugar reaction?

A. 8:30A.M

B. 11A.M

C. 1:30A.M

D. 4P.M

Ans: A

R: Regular Human Insulin which has an onset of action of 1/2 hour to 1 hour, peak effect in 2 to
4 hours, and duration of action of 6 to 8 hours.

81. The nurse evaluates the client's ability to self monitor blood glucose level at home. What
information best indicates the average degree of diabetes control during the past 2-4 months?

A. Serum glycosylated hemoglobin

B. Postprandial blood glucose level

C. A written record of daily blood glucose levels

D. A written record of daily double voided urine glucose levels

Ans: C

R: Daily written record of SMBG allows people with diabetes to monitor their condition and
manage it on a day-to-day basis through the adjustment of treatment and lifestyle factors.

82. Following brain surgery, the client suddenly exhibits polyuria and begins voiding 15-20
L/day. Specific gravity of the urine is 1.006. The nurse will recognize these symptoms as the
possible development of:
A. Diabetes insipidus

B. Diabetes type 1

C. Diabetes type 2

D. Addison's disease

Ans: A

R: Low specific gravity (SG) may indicate the presence of diabetes insipidus

83. A person with a diagnosis of adult diabetes, type 2, should understand the symptoms of a
hyperglycemic reaction. The nurse will know this client understands if she says these symptoms
are:

A. Thirst, polyuria and decreased appetite

B. Flushed cheeks, acetone breath, and increased thirst

C. Nausea, vomiting and diarrhea

D. Weight gain, normal breath and thirst

Ans: B

R: Flushed cheecks, acetone breath, and increased thirst are one of the early signs and symptoms
diabetes type 2 hyperglycemia

84. The non-insulin dependent diabetic who is obese is best controlled by weight loss because
obesity:

A. Reduces the number of insulin receptors

B. Causes pancreatic islet cell exhaustion

C. Reduces insulin binding receptor sites

D. Reduces pancreatic insulin production

Ans: D

R: Weight gain and obesity can reduce pancreatic insulin production

85. A nursing assessments for initial signs of hypoglycemia will include:

A. Pallor, blurred vision, weakness, behavioral changes

B. Frequent urination, flushed face, pleural friction rub

C. Abdominal pain, diminished deep tendon reflexes, double vision

D. Weakness, lassitude, irregular pulse, dilated pupils

Ans: A

R: Weakness,fainting, blurred vision, pallor and perspirationare all common symptoms when
there is toomuch insulin or too little food – hypoglycemia. The signs and symptoms inanswers
(b) and (c) are indicative of hyperglycemia.

86. A client has a diagnosis of diabetes. His physician has ordered short and long acting insulin.
When administering two type of insulin, the nurse would:

A. Withdraw the long acting insulin into syringe before the short acting insulin

B. Withdraw the short acting insulin into syringe before the long acting insulin

C. Draw up in two separates syringes, then combine in one syringe

D. Withdraw long acting insulin, inject air into regular insulin and withdraw insulin

Ans: B

R: When mixing rapid- or short-acting insulin with intermediate- or long-acting insulin, the clear
rapid- or short-acting insulin should be drawn into the syringe first.

87. The nurse explains to a client who has just received the diagnosis of type 2 non-insulin
dependent diabetes mellitus (NIDDM) that sulfonylureas, one group of oral hypoglycemic
agents, as act by:

A. Stimulating the pancreas to produce or release insulin

B. Making the insulin that is produce more available for use

C. Lowering the blood sugar by facilitating the uptake and utilization of glucose

D. Altering both fat and protein metabolism

Ans: A

R: Sulfonylurea drugs, Orinase for example,lowers the blood sugar by stimulating thebeta cells
of the pancreas to synthesize andrelease insulin.

88. The nurse is teaching a diabetic client to monitor glucose using a glucometer. The nurse will
know the client is competent in performing her finger-stick to obtain blood when she:

A. Uses a ball of a finger as the puncture site

B. Uses the side of fingertip as the puncture site

C. Avoid uisng the fingers of her dominant hand as puncture sites

D. Avoid using the thumbs as puncture sites

Ans: B

R: Best locations for a finger stick is the 3rd and 4th fingers of the non-dominant hand. Avoid
the 2nd and 5th fingers if possible. Perform the stick off to side of the center of the finger.
NEVER use the tip or center of the finger.

89. Kim is scheduled for a liver biopsy. What instructions regarding respiration is essential for
the nurse to give him prior to the biopsy.

A. Exhale forcefully and to hold his breath for a few seconds

B. Hold his breath when the needle has reached the liver site

C. Take several deep breaths and to hold his breath while needle is being introduced

D. Flat with one pillow under his head

Ans: C

R: The nurse needs to instruct the patient to hold his/her breath for 5-10 seconds when the needle
is quickly pushed in and out. This is because the liver moves slightly when you breathe in and
out. As the needle comes out it brings with it a small sample of liver tissue

90. Which position in bed would be best for kim immediately after he has the needle biopsy of
the liver?

A. On his right side, with a small pillow under the costal margin

B. Anyway that he is comfortable

C. Semi-fowler with his knees-flexed

D. Flat with one pillow under his head

Ans: A

R:The patient should be in a right side position, near the edge of the bed to avoid pressure.

91. A blakemore sengstaken tube is inserted to prevent bleeding from esophageal varices. The
nurse responsibility in this instance would be to:

A. Alternate inflate and deflate the esophageal balloon

B. Make certain that the desired degree of pressure is constantly maintained

C. Deflate both balloons periodically

D. Encourage kim to swallow frequently while tube is 1 place

Ans: A

92. A physician orders the deflation of the esophageal balloon of a sengstaken-balkemore tube in
a client. The nurse prepares for the procedure knowing that the deflation of the esophageal
balloon places. The client is at risk for:

A. Increase ascites

B. Esophageal necrosis

C. Recurrent hemorrhage from the esophageal varices

D. Gastritis

Ans: C

93. Foods usually omitted from diet of kim with cirrhosis of liver are:

A. Whole grain cereals

B. Milk products

C. Cereal products

D. Rich gravies and sauces

Ans: D

94. Clay colored stool are caused by:

A. Improper utilization of vitamin K by the body

B. The absence of bile salt in the feces

C. The absence of bile pigments in the urine

D. Rich gravies and sauces

Ans: B

95. Kim develop ascites, this is caused by:

A. Pulmonary failure
B. Portal obstruction

C. Capillary obstruction

D. Arterial obstruction

Ans: B

96. Symptoms indicating progression into hepatic coma include:

1. Flapping tumor

2. Nystagmus

3. Fruity odor breath

4. Fetid breath

A. 2 and 4

B. 1 and 4

C. 2 and 3

D. 1 and 3

Ans: B

97. A client admitted to the hospital with a diagnosis of cirrhosis has massive ascites and has difficulty
breathing. A nurse performs which intervention as a priority measure to assist the client with
breathing ?

A. Auscultates the lung fields every 4 hrs

B. Repositions side to side every 2 hrs

C. Encourages deep breathing exercises every 2 hrs

D. Elevates the head of the bed 60 degrees

Ans: D

98. When the client asks the nurse how she acquired hepatitis A, the best answer is that a common
route of hepatitis. A transmission is from:

A. Fecal contamination

B. Insect carries

C. Infected blood
D. Wound drainage

Ans: A

R: Hepatitis A (HepA) is a virus that causes liver disease. It's primarily spread through consuming food or
water that has been contaminated by human feces, but it can also be spread through close contact.

99. It is essential that the nurse inform the client with hepatitis B that for the remainder of his lifetime
he must avoid:

A. Sexual activity

B. Donating blood

C. Excessive caffeine

D. Foreign travel

Ans: A

R: Hepatitis A virus is passed from person to person through the "faecal-oral" route. This means that
minute traces of hepatitis A virus contained in faecal matter on the hands of an infected person make it
into the mouth of an uninfected person. Transmission may occur from contaminated food, liquid or
eating utensils, or during sex.

100. Which nursing action is appropriate prior to assissting with the paracentesis?

A. The nurse ask the client to void

B. The nurse withholds food and water

C. The nurse cleanses the clients abdomen with betadine

D. The nurse obtains a suction machine from storage room

Ans: A

R: Before the procedure begins, tha patient will be asked to void. This helps prevent injury to the
bladder during the procedure.