| D) | Low-fat dairy products
| 1. | The nurse is planning and providing the care of a patient with heart failure (HF). What will be the overall goals of management for this patient? Select all that apply. | | A) | Improve functional status | | B) | Increase cardiac contractility | | C) | Extend survival | | D) | Decrease pulmonary venous pressure | | E) | Relieve patient symptoms |
| 2. | The nurse is providing care for a patient newly diagnosed with systolic heart failure (HF). What medications should the nurse anticipate administering? | | A) | Beta-blockers | | B) | Calcium channel blockers | | C) | Alpha agonists | | D) | Angiotensin prohibiters |
| 3. | The nurse has conducted a comprehensive assessment of a new resident of a long-term care facility. Which assessment data, collected by the nurse, indicate the most significant increase in a patient’s risk for heart failure (HF)? | | A) | Lasix 20 mg/day PO | | B) | Potassium level of 5.7 mEq/L | | C) | African American race | | D) | Age of 65 years or older |
| 4. | The nurse is providing discharge teaching to a patient diagnosed with heart failure. What should the nurse teach this patient to do to monitor fluid balance? | | A) | Monitor blood pressure. | | B) | Assess radial pulses. | | C) | Monitor weight daily. | | D) | Monitor bowel movements |
| 5. | The nurse is assessing for hepatojugular reflux in a patient with a history of heart failure. When performing this assessment, the nurse will: | | A) | Elevate the patient’s head to 90 degrees | | B) | Press the patient’s right upper abdomen | | C) | Palpate the patient’s jugular veins simultaneously | | D) | Lay the patient flat in bed |
| 6. | The nurse has attended morning report on a busy medical unit. The nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock? | | A) | The patient admitted with acute renal failure. | | B) | The patient admitted following a myocardial infarction (MI). | | C) | The patient admitted following hypertensive urgency. | | D) | The patient admitted following a stroke. |
| 7. | When assessing the patient with pericardial effusion, the nurse will assess for pulsus paradoxus. Pulsus paradoxus is characterized by: | | A) | A diastolic blood pressure that is lower during exhalation. | | B) | A diastolic blood pressure that is higher during inhalation. | | C) | A systolic blood pressure that is higher during exhalation. | | D) | A systolic blood pressure that is lower during inhalation. |
| 8. | The cardiac monitor alarm alerts the critical care nurse that the patient is showing no cardiac rhythm on the monitor. When the nurse assesses the patient, the patient is found to be experiencing cardiac arrest. In providing cardiac resuscitation documentation, how will the nurse describe this initial absence of cardiac rhythm? | | A) | Pulseless electrical activity (PEA) | | B) | Ventricular fibrillation | | C) | Ventricular tachycardia | | D) | Asystole |
| 9. | The nurse is performing a physical assessment on a patient suspected of being in heart failure. During auscultation, heart failure would be suggested by: | | A) | An S3 heart sound | | B) | Crackles | | C) | Wheezing | | D) | An S4 heart sound |
| 10. | A nurse has asked the unit educator what happens when the amount of fluid in the pericardial sac increases. What should the educator tell the nurse? | | A) | It raises the pressure inside the pericardial sac, causing fluid to leak through. | | B) | It raises the pressure inside the pericardial sac, compressing the lungs. | | C) | It raises the pressure inside the pericardial sac, compressing the heart. | | D) | It raises the pressure inside the pericardial sac, causing it to rupture. |
| 11. | A 69-year-old man has been experiencing progressive dyspnea and activity intolerance in recent months and is currently undergoing a diagnostic workup for heart failure (HF). During echocardiography, systolic HF could be differentiated from diastolic HF by appraising the patient’s: | | A) | Sinus rhythm | | B) | Ejection fraction (EF) | | C) | Stroke volume | | D) | Left ventricular wall thickness |
| 12. | The nurse recognizes that an older adult patient with heart failure is experiencing the effects of inadequate cardiac output, a problem that affects many of the body’s systems. Inadequate perfusion of the patient’s kidneys leads to which of the following pathophysiological effects? | | A) | Decreased erythropoiesis | | B) | Acid–base imbalances | | C) | Hyperkalemia | | D) | Increased renin release |
| 13. | A patient has been admitted to the hospital with exacerbation of heart failure (HF) that has resulted in pulmonary and peripheral edema. The nurse has been carefully monitoring the trajectory of the patient’s signs and symptoms of HF. How can the nurse best monitor the patient’s fluid balance? | | A) | By monitoring the patient’s blood urea nitrogen (BUN) and creatinine levels | | B) | By measuring and recording the patient’s oral fluid intake | | C) | By performing daily weights at the same time each day | | D) | By assessing the patient’s skin turgor at several different sites |
| 14. | The nurse has completed a head-to-toe assessment of a patient who was admitted for the treatment of heart failure (HF). Which of the following assessment findings should signal to the nurse a possible exacerbation of the patient’s condition? | | A) | Crackles are audible on chest auscultation. | | B) | The patient’s blood pressure (BP) is 144/99. | | C) | The patient has put out 600 mL of dilute urine over the past 8 hours. | | D) | Blood glucose testing reveals a glucose level of 158 mg/dL. |
| 15. | A patient has been newly diagnosed with heart failure (HF) and has come to the meet with the nurse at the clinic for health education. What lifestyle recommendation should the nurse provide to this patient when discussing dietary modifications? | | A) | “It’s in your best interests to avoid excessive fluids and sodium in your diet.” | | B) | “Try to replace as many of the complex carbohydrates in your diet with simple sugars.” | | C) | “I’ll teach you some good sources of potassium, which you should try to eat regularly.” | | D) | “Many people with HF find that small, frequent meals allow them to manage their diet effectively.” |
| 16. | The nurse is conducting a morning assessment of an 80-year-old female patient who has a longstanding diagnosis of heart failure (HF). The nurse notes an elevation in jugular venous pressure (JVP) greater than 4 cm above the woman’s sternal angle, a finding that did not exist the day before. What conclusion should the nurse draw from this assessment finding? | | A) | The woman is demonstrating the early signs of cardiogenic shock. | | B) | The woman has left-sided heart failure. | | C) | The woman is also likely to experience shortness of breath. | | D) | The woman may be experiencing an exacerbation of right-sided HF. |
| 17. | A community health nurse is participating in a healthy-living workshop that has been sponsored by a local seniors’ center. The discussion has turned to the problem of heart failure, and the nurse is emphasizing preventative measures. When teaching older adults to decrease their future risks of developing heart failure, the nurse should emphasize what action? | | A) | Effective stress management | | B) | A low-fat, high-protein diet | | C) | Physical exercise and the importance of getting 30 to 60 minutes of activity each day | | D) | Close blood pressure monitoring and vigilant adherence to hypertension therapy |
| 18. | A nurse has performed an assessment of a patient and subsequently administered the patient’s scheduled dose of ramipril, an angiotensin-converting enzyme (ACE) inhibitor prescribed for the treatment of the patient’s longstanding heart failure (HF). The nurse understands that this drug will aid in the treatment of the patient’s disease by: | | A) | Reducing the patient’s overall oxygen demand | | B) | Reducing preload through the excretion of fluid and sodium | | C) | Increasing the contractility of the heart and increasing ejection fraction | | D) | Causing vasodilation and decreasing the heart’s workload |
| 19. | A patient has developed pulmonary edema during an exacerbation of heart failure. The patient is experiencing dyspnea primarily because of the accumulation of pressure in the patient’s: | | A) | Right atrium | | B) | Right ventricle | | C) | Left atrium | | D) | Left ventricle |
| 20. | An elderly patient is experiencing an acute onset of pulmonary edema with a cardiac etiology. When assessing the patient, what findings should the nurse identify as being consistent with this diagnosis? Select all that apply. | | A) | Hypotension | | B) | Rales | | C) | Fever | | D) | Cold, moist skin | | E) | Weak, rapid pulse |
| 21. | A 70-year-old man has been living with a diagnosis of heart failure (HF) for several years and has been vigilant about monitoring the trajectory of disease and adhering to his prescribed treatment regimen. The man has scheduled an appointment with his primary care provider because he has noted a weight gain of 6 pounds over the past week. The nurse should anticipate that this patient may benefit from which of the following treatment measures? | | A) | A further reduction in his dietary sodium intake | | B) | An increase in the dose of his prescribed diuretic | | C) | A decrease in his daily activity level | | D) | Thoracentesis |
| 22. | A patient has been admitted to the medical unit because of an exacerbation of heart failure. Over the past hour, the patient has become increasingly restless, tachypneic, and short of breath, and pulse oximetry reveals SaO2 of 78%. Which of the following actions should the nurse prioritize? | | A) | Providing reassurance to calm the patient and slow the patient’s respiratory rate | | B) | Protecting the patient’s airway and taking measures to promote gas exchange | | C) | Monitoring the patient’s cardiac function | | D) | Obtaining a complete set of vital signs |
| 23. | A critical care nurse is providing care for a patient who was admitted to the intensive care unit after going into cardiogenic shock while on one of the hospital’s medical units. This nurse should plan assessments and interventions in the knowledge that the effects of cardiogenic shock primarily result from: | | A) | Tissue hypoperfusion | | B) | Toxic effects of cardiac biomarkers | | C) | Overcompensation by the autonomic nervous system (ANS) | | D) | Osmotic changes |
| 24. | A nurse in the cardiac critical care unit is assisting with pericardiocentesis for a patient who developed a pericardial effusion. Which of the following outcomes would suggest that the procedure has achieved the desired effect? | | A) | The patient’s arterial blood gases normalize | | B) | The patient’s pulse pressure narrows | | C) | The patient’s heart rate increases | | D) | The patient’s blood pressure increases |
| 25. | A nurse has been providing care for an older adult patient who has a number of comorbid medical conditions. The nurse has been performing frequent assessment throughout the morning due to the patient’s pallor, decreased level of consciousness, and unstable vital signs. During the nurse’s most recent assessment, the patient has lost consciousness and the carotid pulse is not palpable. What is the nurse’s priority action? | | A) | Applying oxygen by face mask | | B) | Performing a rapid head-to-toe assessment | | C) | Initiating cardiopulmonary resuscitation | | D) | Activating the hospital’s code system |
| 1. | The nurse is caring for a patient with a hematologic disorder. The patient asks the nurse where the body forms blood cells. Where should the nurse tell the patient that blood cells are formed? | | A) | In the spleen | | B) | In the kidneys | | C) | In the bone marrow | | D) | In the liver |
| 2. | An elderly adult trips over her dog and receives an injury to her skin that causes minor blood loss. Primary hemostasis is activated in this patient. What occurs during primary hemostasis? | | A) | Severed blood vessels constrict. | | B) | Thromboplastin is released. | | C) | Prothrombin is converted to thrombin. | | D) | Fibrin is lysed. |
| 3. | A patient has come to the Ob-Gyn clinic with complaints of a heavy menstrual flow. The nurse knows that red blood cell production will be increased in the patient’s body. Because of this, the nurse is aware that the patient may need to increase her daily intake of what? | | A) | Vitamin C | | B) | Vitamin D | | C) | Iron | | D) | Magnesium |
| 4. | A patient with renal failure has decreased erythropoietin production. Upon analysis of the patient’s complete blood count (CBC), the nurse will expect which of the following CBC results? | | A) | An increased hemoglobin and hematocrit | | B) | A decreased hemoglobin and hematocrit | | C) | A decreased mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) | | D) | An increased MCV and MCH |
| 5. | A patient has asked the nurse about the clotting cascade, and the nurse explains that plasminogen is a component necessary in the clotting cascade. Where in the body is plasminogen present? | | A) | Myocardial muscle tissue | | B) | All body fluids | | C) | Cerebral tissue | | D) | Renal cells |
| 6. | The nurse is caring for a patient whose bone marrow has been replaced by scar tissue in much of the areas that produce blood cells for the body. What organs can become active in blood cell production by the process of extramedullary hematopoiesis? | | A) | Spleen and kidneys | | B) | Kidneys and pancreas | | C) | Pancreas and liver | | D) | Liver and spleen |
| 7. | The nurse is working with a patient who has a hematological disorder. The nurse is aware that, in the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what broad cell types do myeloid stem cells differentiate? Select all that apply. | | A) | Leukocytes | | B) | Mast cells | | C) | Thrombocytes | | D) | Platelets | | E) | Erythrocytes |
| 8. | A child has suffered a laceration in a playground accident. When a human body receives an injury that causes blood loss, several processes are involved in maintaining hemostasis. When a blood clot is no longer needed, what digests the fibrinogen and fibrin? | | A) | Plasminogen | | B) | Thrombin | | C) | Prothrombin | | D) | Plasmin |
| 9. | The nurse is providing care for a patient with a diagnosis of cellulitis. What laboratory value would the nurse assess most closely to gauge the patient’s infection? | | A) | Creatinine levels | | B) | Hepatic function tests | | C) | Electrolyte levels | | D) | White blood cell (WBC) count |
| 10. | A patient with esophageal varices secondary to liver cirrhosis has received a transfusion of frozen plasma. The nurse is aware of the fact that plasma: | | A) | Acts solely as a solvent for the cellular components of the blood | | B) | Accounts for the majority of the blood’s volume in the body | | C) | Plays a regulatory role in the process of erythropoiesis | | D) | Primarily regulates the pH of blood and other body fluids |
| 11. | A patient’s most recent blood work reveals an elevated level of reticulocytes. The nurse recognizes that this assessment finding may be suggestive of: | | A) | An infectious process | | B) | A lack of oxygen-carrying capacity | | C) | Fluid volume deficit | | D) | Oxygen toxicity |
| 12. | A nurse is aware of the central role that erythropoietin plays in the initiation of erythropoiesis. Which of the following individuals would be likely to require administration of exogenous erythropoietin? | | A) | A woman who experienced a postpartum hemorrhage after spontaneous vaginal delivery | | B) | A child who experienced severe blood loss during a motor vehicle accident | | C) | A woman who has been diagnosed with hepatic encephalopathy after a long history of alcohol abuse | | D) | A man with a diagnosis of acute renal failure secondary to type 1 diabetes |
| 13. | A patient’s most recent complete blood count (CBC) reveals that her mean corpuscular volume (MCV) is well below reference ranges. The nurse should identify what potential contributing factor for this phenomenon? | | A) | The woman has an iron deficiency. | | B) | The woman has been exposed to carbon monoxide at some point in the past. | | C) | The woman is experiencing nephrotoxicity. | | D) | The woman’s oxygen demands are currently lower than normal. |
| 14. | A nurse is reviewing the admission blood work of an adult woman who presented with complaints of progressive fatigue over the past several weeks. The woman’s subsequent blood work is indicative of iron-deficiency anemia. What assessment question by the nurse most directly addresses the potential cause of the woman’s iron deficiency? | | A) | “Would you say that you tend to eat a well-balanced diet?” | | B) | “Have you noticed lately that you are passing less urine or that your urine is quite dilute?” | | C) | “Have you seen any blood when you have had a bowel movement in recent weeks?” | | D) | “Have you had a bad cold or a case of the flu in the past few weeks?” |
| 15. | A 66-year-old man underwent a successful partial gastrectomy for the treatment of stomach cancer 3 years ago. The man had a scheduled follow-up appointment with his primary caregiver and had blood work completed. The results of the man’s blood work indicated anemia. The nurse who is contributing to the patient’s care should recognize that this patient’s anemia may be attributable to what factor? | | A) | A recurrence of the man’s cancer | | B) | Paralytic ileus | | C) | Infection | | D) | Decreased vitamin B12 absorption |
| 16. | A patient’s health care provider has ordered blood work that included a white blood cell (WBC) differential. The results of this blood test reveal a bandemia, in which the patient’s WBC count indicates a higher-than-normal proportion of band cells. What should the nurse infer from this assessment finding? | | A) | The patient is currently fighting an infection. | | B) | The patient is deficient in folic acid and/or iron intake. | | C) | The patient’s kidneys are under physiological duress. | | D) | The patient should be assessed for leukemia and Hodgkin’s disease. |
| 17. | A patient with a diagnosis of HIV exhibits a decreased level of T lymphocytes. What consequence does this state present for this patient? | | A) | The patient will be incapable of mounting a response to allergens. | | B) | The patient is particularly susceptible to infection. | | C) | The patient has diminished oxygen-carrying capacity. | | D) | The patient will be unable to maintain hemostasis. |
| 18. | A patient with a diagnosis of hepatitis C is being treated in the medical unit of the hospital and has experienced a downward trend in albumin levels. In light of this diagnostic finding, what assessments should the nurse prioritize? | | A) | Assessment of the patient’s integumentary system and assessment for skin breakdown on dependent surfaces | | B) | Assessment of the patient’s fluid balance and assessment for third-spacing and edema | | C) | Assessment of the patient’s urine output, creatinine levels, and blood urea nitrogen (BUN) levels | | D) | Assessment for signs and symptoms of metabolic acidosis and metabolic alkalosis |
| 19. | A nurse administered a subcutaneous injection to a patient and noted a small amount of bleeding from the administration site. After a minute, the bleeding ceased, a process that the nurse attributed to hemostasis. Which of the following physiological phenomena occurred during secondary hemostasis? | | A) | The patient’s blood vessels surrounding the injection site constricted. | | B) | Platelets aggregated at the site where the bleeding occurred. | | C) | The patient’s plasma fibrinolytic system was activated. | | D) | The patient’s clotting cascade resulted in the formation of fibrin. |
| 20. | An 82-year-old resident of a long-term care facility has had a scheduled appointment with his primary care provider and had blood work drawn thereafter. The results of the resident’s blood work are suggestive of anemia. How should the nurse best interpret this laboratory finding? | | A) | Mild to moderate anemia is considered a normal, age-related change. | | B) | The resident’s anemia is likely the result of psychological stressors. | | C) | The specific etiology of the resident’s anemia should be investigated. | | D) | The resident would benefit from a high-iron diet and folic acid supplements. |
| 21. | An older adult with a history of decreased self-care has been admitted to the geriatric medical unit after being found in state of dehydration and malnutrition by paramedics. The admission assessment of the patient included a complete blood count, which revealed several hematological abnormalities, including a hematocrit of 61%. The nurse should consequently assess the patient for signs and symptoms of: | | A) | Gastrointestinal bleeding or other internal hemorrhage | | B) | Spontaneous clotting and thromboembolism | | C) | Confusion and decreased level of consciousness | | D) | Activity intolerance |
| 22. | A 44-year-old man with a longstanding diagnosis of AIDS has been admitted to the hospital with an absolute neutrophil count (ANC) of 385/mm3. When planning the patient’s care, what action should the nurse prioritize? | | A) | Placing the patient on protective isolation precautions | | B) | Obtaining the patient’s blood type and cross-match in anticipation of transfusion | | C) | Providing the patient with supplementary oxygen by simple face mask | | D) | Padding hard surfaces on the patient’s bed to reduce the risk of injury |
| 23. | While performing a morning assessment of an elderly patient on a subacute medical unit, the nurse notes petechiae on a patient’s lower extremities. When checking this patient’s most recent blood work, the nurse should pay particular attention to the patient’s level of: | | A) | Platelets | | B) | Neutrophils | | C) | Iron | | D) | Albumin |
| 24. | A patient with a recent history of hematologic abnormalities has been scheduled for a bone marrow biopsy. The patient has expressed to the nurse, “That sounds like an incredibly painful experience.” How should the nurse best respond to this patient’s concern? | | A) | “Actually, you won’t feel anything other than the initial shot where the doctor injects anesthetic.” | | B) | “A bone marrow biopsy can be a painful experience, but know that it is only ordered when absolutely necessary.” | | C) | “There is some pressure and pain when the doctor removes the marrow, but this should only be short-lasting.” | | D) | “The doctor will inject some anesthetic into your bone a few hours ahead of time reduce the pain associated with the procedure.” |
| 25. | The nurse is providing patient education in anticipation of the patient’s scheduled boned marrow aspiration and biopsy. When teaching the patient about care after the procedure, the nurse should encourage the patient to do which of the following? | | A) | Take aspirin to alleviate pain. | | B) | Remain on bed rest for 24 to 36 hours after the procedure. | | C) | Avoid bathing until the site heals. | | D) | Avoid the use of oral analgesics. |
| 1. | An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test? | | A) | Stool will be yellow for the first 24 hours postprocedure. | | B) | The barium may cause diarrhea. | | C) | Fluids must be increased to facilitate the evacuation of the stool. | | D) | This series includes analysis of gastric secretions. |
| 2. | A patient has come into the radiology department to undergo testing for possible polyps. What diagnostic test may be done to diagnose this type of lesion? | | A) | Gastric analysis | | B) | Barium enema | | C) | Barium swallow | | D) | Gastroscopy |
| 3. | The nurse is caring for a patient who is scheduled for a gastroscopy. What preparation is needed for a gastroscopy? | | A) | Insert a nasogastric tube. | | B) | Administer a micro Fleet enema. | | C) | Have the patient lie in a dorsal position. | | D) | Spray or gargle the back of the throat with local anesthetic. |
| 4. | A patient is scheduled to have a fecal occult blood test. Before the test, the nurse should instruct the patient to avoid: | | A) | Inspection, auscultation, percussion, and palpation | | B) | Inspection, auscultation, palpation, and percussion | | C) | Inspection, percussion, palpation, and auscultation | | D) | Inspection, palpation, percussion, and auscultation |
| 5. | The nurse is preparing to perform an abdominal assessment of a newly admitted patient. When performing an abdominal assessment, what examination sequence should the nurse follow? | | A) | Inspection, auscultation, percussion, and palpation | | B) | Inspection, auscultation, palpation, and percussion | | C) | Inspection, percussion, palpation, and auscultation | | D) | Inspection, palpation, percussion, and auscultation |
| 6. | A nurse is caring for a newly admitted patient with a suspected gastrointestinal (GI) bleed. The nurse assesses the patient’s stool after a bowel movement and notes it to be a tarry-black color. The nurse recognizes that the bleeding is likely occurring where? | | A) | The lower GI tract | | B) | The upper GI tract | | C) | The esophagus | | D) | The anal area |
| 7. | The nurse is providing care for a patient whose cancer has metastasized to her small intestine. What does the small intestine do? Select all that apply. | | A) | Creation of human waste products | | B) | Reabsorption of water to maintain blood pressure | | C) | Secretion | | D) | Absorption | | E) | Movement of nutrients into the blood stream. |
| 8. | A nurse is reviewing the liver function panel of a patient’s most recent blood work. What liver function test is a sensitive indicator of injury to liver cells and useful in detecting acute liver disease such as hepatitis? | | A) | Clotting factors | | B) | Serum aminotransferases | | C) | GGT | | D) | Alkaline phosphatase |
| 9. | The nurse is caring for a patient who has a gallstone blocking his bile duct. When the nurse assesses the patient’s laboratory studies, what would be an expected finding? | | A) | Increased bilirubin level in the blood | | B) | Decreased cholesterol level | | C) | Increased blood urea nitrogen (BUN) level | | D) | Decreased serum alkaline phosphatase level |
| 10. | A nurse is explaining to a patient about an ultrasound of the gallbladder the patient is going to have the following morning. What will the nurse do in preparation for this diagnostic study? | | A) | Initiate NPO status 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. |
| 11. | Following a CT and biopsy, a female patient has received a diagnosis of mesenteric cancer. What is the physiologic function of a mesentery? | | A) | Surrounding and protecting many of the organs in the gastrointestinal tract | | B) | Secreting exocrine digestive enzymes into the peritoneal space | | C) | Producing the rhythmic muscular contractions of peristalsis | | D) | Resorbing excess bile between meals and while an individual is fasting |
| 12. | The complex and diverse functions of the gastrointestinal (GI) tract require precise innervation. Which of the following statements most accurately conveys an aspect of the neurology of the GI tract? | | A) | Digestion and secretion are primarily results of the sympathetic nervous system (SNS), which is activated by food intake. | | B) | The majority of the lower GI tract is directly innervated by the central nervous system (CNS). | | C) | Sympathetic stimulation exerts an inhibitory effect, decreasing gastric secretion and motility. | | D) | Parasympathetic activity slows most of the secretory functions within the GI tract. |
| 13. | An individual has had a snack consisting of half a bagel with cream cheese, lox (smoked salmon), red onions, and capers. Stimulation of the person’s gastrointestinal tract has resulted in the secretion of numerous digestive enzymes into the small intestine, including trypsin. What component of this person’s snack will be primarily digested by the action of trypsin? | | A) | The bagel | | B) | The lox | | C) | The cream cheese | | D) | The red onions and capers |
| 14. | An elderly patient has developed Clostridium difficile-related diarrhea, a problem that has led to dehydration and hypokalemia. The increased peristalsis that characterizes diarrhea has the potential to cause fluid volume deficit and electrolyte deficits because: | | A) | Increased peristalsis diverts energy away from the absorptive activities of the small intestine. | | B) | Increased peristalsis creates increased metabolic demand, which in turn depletes fluid and electrolyte reserves. | | C) | An increase in peristalsis means that the colon cannot absorb the substances that it normally absorbs. | | D) | An increase in peristalsis reduces the normal surface area of the villi and microvilli in the colon. |
| 15. | The liver performs numerous functions that contribute to homeostasis, including the synthesis of bile. How is bile utilized in the processes of digestion and absorption? | | A) | Bile is produced in the liver in response to meals that are high in protein. | | B) | Bile is stored in the gallbladder until it is needed for carbohydrate metabolism. | | C) | Bile is produced in the liver but released by the gallbladder when needed for digesting fats. | | D) | Bile production increases when an individual’s fat intake is reduced over several days. |
| 16. | As part of a newly admitted patient’s admission assessment, the nurse is questioning the patient about risk factors for liver disease. Which of the following questions most directly addresses these risk factors? | | A) | “How much alcohol do you typically drink?” | | B) | “Do you know if your immunizations are up to date?” | | C) | “What do you do for a living?” | | D) | “Do you have any chronic illnesses that your care team is not aware of?” |
| 17. | A patient with a history of liver cirrhosis has experienced a recent exacerbation in the signs and symptoms of his disease and has consequently been admitted to the hospital. The patient exhibits a firm, distended abdomen, and an abdominal ultrasound confirms a diagnosis of ascites. When reviewing this patient’s blood work, what value is most congruent with the presence of ascites? | | A) | Increased D-dimer levels | | B) | Decreased levels of amylase | | C) | Increased levels of B-type natriuretic peptide (BNP) | | D) | Decreased levels of albumin |
| 18. | The nurse is receiving the morning report about a patient who is being treated on the hospital’s medical unit. The nurse is informed that the patient’s serum bilirubin level has been trending upward over the past 2 days and is now well above the normal reference range. The nurse should anticipate which of the following assessment findings? | | A) | Dependent edema | | B) | Cold intolerance | | C) | Ascites | | D) | Jaundice |
| 19. | The nurse is conducting an abdominal assessment of a patient who is postoperative day 1 following an open cholecystectomy. During auscultation of the patient’s abdomen, the nurse has noted that clicks and gurgles are audible approximately every 10 seconds. How should the nurse follow up this assessment finding? | | A) | The nurse should administer a p.r.n. stool softener. | | B) | The nurse should contact the patient’s care provider. | | C) | The nurse should assess the patient for paralytic ileus. | | D) | The nurse should document normoactive bowel sounds. |
| 20. | The nurse is providing care for a patient with a diagnosis of cirrhosis. Daily assessment of the patient’s abdominal girth has revealed a gradual increase, and the nurse now wishes to assess for the presence of ascites using a fluid wave test. When conducting this assessment, the nurse should: | | A) | Ask the patient to slowly move from one side-lying position to the other. | | B) | Determine if motion is transmitted from one of the patient’s flanks to the other. | | C) | See if rebound tenderness is symmetrical between the patient’s flanks. | | D) | Determine if the patient’s abdomen maintains its shape during deep palpation. |
| 21. | A 56-year-old presented to her nurse practitioner because she had been experiencing unprecedented constipation and the passage of pencil-like stools despite her high fluid and fiber intake. The nurse recognized the need to assess the patient for colorectal cancer and ordered diagnostic evaluations. What component of the patient’s blood work would be most indicative of the presence of cancer? | | A) | C-reactive protein (CRP) | | B) | Carcinoembryonic antigen (CEA) | | C) | Ceruloplasmin | | D) | Coproporphyrin |
| 22. | A 50-year-old male patient with a history of cholelithiasis (gallstones) has presented to the emergency department (ED) with severe upper right quadrant pain. The ED nurse should anticipate the need to facilitate which of the following diagnostic tests? | | A) | Computed tomography (CT) of the abdomen | | B) | Barium swallow | | C) | Abdominal ultrasonography | | D) | Endoscopic retrograde cholangiopancreatography (ERCP) |
| 23. | A patient with a history of chronic constipation has been scheduled for a lower gastrointestinal tract study (barium enema). The patient has presented to the outpatient clinic at the scheduled time and has expressed anxiety about the potential pain and unpleasantness of the barium enema to the nurse. How should the nurse who will assist with the procedure respond to this patient’s concerns? | | A) | “A barium enema can be uncomfortable but we’ll do it very carefully to minimize this.” | | B) | “A barium enema can be painful, but it does not last long, and we’ll give you painkillers ahead of time.” | | C) | “Actually, most patients report that they hardly even feel the procedure.” | | D) | “The sedatives that we’ll give you will make sure that you don’t remember the procedure.” |
| 24. | A male patient’s present signs and symptoms are suggestive of an incompetent cardiac sphincter, and he has been scheduled for an upper GI series (barium swallow). What preprocedure teaching should the nurse provide to this patient? | | A) | “Make sure to tell your doctor about any allergies to shellfish.” | | B) | “It’s important that you take your laxatives as ordered on the day prior to your barium swallow.” | | C) | “Make sure that you don’t eat anything after midnight the day before your test.” | | D) | “You’ll need to restrict your fluid intake for 24 hours after the test.” |
| 25. | The nurse has noted that a patient’s plasma ammonia levels are trending upward and are currently high-normal (45 mg/dL; 32 mmol/L). The nurse should most likely associate this laboratory finding with: | | A) | Liver disease | | B) | Cholecystitis | | C) | Cancer of the gastrointestinal tract | | D) | Esophageal or gastric ulcers |
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