1.

For a client in hepatic coma, which outcome would be the most

appropriate?
A. The client is oriented to time, place, and person.
B. The client exhibits no ecchymotic areas.
C. The client increases oral intake to 2,000 calories/day.
D. The client exhibits increased serum albumin level.
2. Jordin is a client with jaundice who is experiencing pruritus. Which
nursing intervention would be included in the care plan for the client?
A. Administering vitamin K subcutaneously
B. Applying pressure when giving I.M. injections
C. Decreasing the clients dietary protein intake
D. Keeping the clients fingernails short and smooth
3. Marie, a 51-year-old woman, is diagnosed with cholecystitis. Which diet,
when selected by the client, indicates that the nurses teaching has been
successful?
A. 4-6 small meals of low-carbohydrate foods daily
B. High-fat, high-carbohydrate meals
C. Low-fat, high-carbohydrate meals
D. High-fat, low protein meals
4. The hospital administrator had undergone percutaneous transhepatic
cholangiography. which assessment finding indicates complication after
the operation?
A. Fever and chills
B. Hypertension
C. Bradycardia
D. Nausea and diarrhea
5. When planning home care for a client with hepatitis A, which preventive
measure should be emphasized to protect the clients family?
A. Keeping the client in complete isolation
B. Using good sanitation with dishes and shared bathrooms
C. Avoiding contact with blood-soiled clothing or dressing
D. Forbidding the sharing of needles or syringes
6. For Jayvin who is taking antacids, which instruction would be included in
the teaching plan?
A. Take the antacids with 8 oz of water.
B. Avoid taking other medications within 2 hours of this one.

C. Continue taking antacids even when pain subsides.

D. Weigh yourself daily when taking this medication.
7. Which clinical manifestation would the nurse expect a client diagnosed
with acute cholecystitis to exhibit?
A. Jaundice, dark urine, and steatorrhea
B. Acute right lower quadrant (RLQ) pain, diarrhea, and dehydration
C. Ecchymosis petechiae, and coffee-ground emesis
D. Nausea, vomiting, and anorexia
8. Pierre who is diagnosed with acute pancreatitis is under the care of
Nurse Bryan. Which intervention should the nurse include in the care plan
for the client?
A. Administration of vasopressin and insertion of a balloon tamponade
B. Preparation for a paracentesis and administration of diuretics
C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube
with low intermittent suction
D. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day
9. When teaching a client about pancreatic function, the nurse
understands that pancreatic lipase performs which function?
A. Transports fatty acids into the brush border
B. Breaks down fat into fatty acids and glycerol
C. Triggers cholecystokinin to contract the gallbladder
D. Breaks down protein into dipeptides and amino acids
10. A 52-year-old man was referred to the clinic due to increased
abdominal girth. He is diagnosed with ascites by the presence of a fluid
thrill and shifting dullness on percussion. After administering diuretic
therapy, which nursing action would be most effective in ensuring safe
care?
A. Measuring serum potassium for hyperkalemia
B. Assessing the client for hypervolemia
C. Measuring the clients weight weekly
D. Documenting precise intake and output
11. Which assessment finding indicates that lactulose is effective in
decreasing the ammonia level in the client with hepatic encephalopathy?
A. Passage of two or three soft stools daily
B. Evidence of watery diarrhea
C. Daily deterioration in the clients handwriting
D. Appearance of frothy, foul-smelling stools

12. Nurse Farrah is providing care for Kristoff who has jaundice. Which
statement indicates that the nurse understands the rationale for
instituting skin care measures for the client?
A. Jaundice is associated with pressure ulcer formation.
B. Jaundice impairs urea production, which produces pruritus.
C. Jaundice produces pruritus due to impaired bile acid excretion.
D. Jaundice leads to decreased tissue perfusion and subsequent breakdown.
13. Which rationale supports explaining the placement of an esophageal
tamponade tube in a client who is hemorrhaging?
A. Allowing the client to help insert the tube
B. Beginning teaching for home care
C. Maintaining the clients level of anxiety and alertness
D. Obtaining cooperation and reducing fear
14. For Rico who has chronic pancreatitis, which nursing intervention
would be most helpful?
A. Allowing liberalized fluid intake
B. Counseling to stop alcohol consumption
C. Encouraging daily exercise
D. Modifying dietary protein
15. Mr. Hasakusa is in end-stage liver failure. Which interventions should
the nurse implement when addressing hepatic encephalopathy? (Select all
that apply.)
A. Assessing the clients neurologic status every 2 hours
B. Monitoring the clients hemoglobin and hematocrit levels
C. Evaluating the clients serum ammonia level
D. Monitoring the clients handwriting daily
E. Preparing to insert an esophageal tamponade tube
F. Making sure the clients fingernails are short
16. For a client with hepatic cirrhosis who has altered clotting
mechanisms, which intervention would be most important?
A. Allowing complete independence of mobility
B. Applying pressure to injection sites
C. Administering antibiotics as prescribed
D. Increasing nutritional intake
17. A client with advanced cirrhosis has been diagnosed with hepatic
encephalopathy. The nurse expects to assess for:

A. Malaise
B. Stomatitis
C. Hand tremors
D. Weight loss
18. A client diagnosed with chronic cirrhosis who has ascites and pitting
peripheral edema also has hepatic encephalopathy. Which of the following
nursing interventions are appropriate to prevent skin breakdown? (Select
all that apply.)
A. Range of motion every 4 hours
B. Turn and reposition every 2 hours
C. Abdominal and foot massages every 2 hours
D. Alternating air pressure mattress
E. Sit in chair for 30 minutes each shift
19. Which of the following will the nurse include in the care plan for a
client hospitalized with viral hepatitis?
A. Increase fluid intake to 3000 ml per day
B. Adequate bed rest
C. Bland diet
D. Administer antibiotics as ordered
20. Spironolactone (Aldactone) is prescribed for a client with chronic
cirrhosis and ascites. The nurse should monitor the client for which of the
following medication-related side effects?
A. Jaundice
B. Hyperkalemia
C. Tachycardia
D. Constipation
Answers and Rationale
Here are the answers for this exam. Gauge your performance by counter checking
your answers to those below. If you have any disputes or clarifications, please direct
them to the comments section.
1. Answer: A. The client is oriented to time, place, and person.
Hepatic coma is the most advanced stage of hepatic encephalopathy. As hepatic
coma resolves, improvement in the clients level of consciousness occurs. The client
should be able to express orientation to time, place, and person. Ecchymotic areas
are related to decreased synthesis of clotting factors. Although oral intake may be
related to level of consciousness, it is more closely related to anorexia. The serum
albumin level reflects hepatic synthetic ability, not level of consciousness.

2. Answer: D. Keeping the clients fingernails short and smooth

The client with pruritus experiences itching, which may lead to skin breakdown and
possibly infection from scratching. Keeping his fingernails short and smooth helps
prevent skin breakdown and infection from scratching. Applying pressure when
giving I.M. injections and administering vitamin K subcutaneously are important if
the client develops bleeding problems. Decreasing the clients dietary intake is
appropriate if the clients ammonia levels are increased.
3. Answer: C. Low-fat, high-carbohydrate meals
For the client with cholecystitis, fat intake should be reduced. The calories from fat
should be substituted with carbohydrates. Reducing carbohydrate intake would be
contraindicated. Any diet high in fat may lead to another attack of cholecystitis.
4. Answer: A. Fever and chills
Septicemia is a common complication after a percutaneous transhepatic
cholangiography. Evidence of fever and chills, possibly indicative of septicemia, is
important. Hypotension, not hypertension, is associated with septicemia.
Tachycardia, not bradycardia, is most likely to occur. Nausea and diarrhea may
occur but are not classic signs of sepsis.
5. Answer: B. Using good sanitation with dishes and shared bathrooms
Hepatitis A is transmitted through the fecal oral route or from contaminated water
or food. Measures to protect the family include good handwashing, personal
hygiene and sanitation, and use of standard precautions. Complete isolation is not
required. Avoiding contact with blood-soiled clothing or dressings or avoiding the
sharing of needles or syringes are precautions needed to prevent transmission of
hepatitis B.
6. Answer: B. Avoid taking other medications within 2 hours of this one.
Antacids neutralize gastric acid and decrease the absorption of other medications.
The client should be instructed to avoid taking other medications within 2 hours of
the antacid. Water, which dilutes the antacid, should not be taken with antacid. A
histamine receptor antagonist should be taken even when pain subsides. Daily
weights are indicated if the client is taking a diuretic, not an antacid.
7. Answer: D. Nausea, vomiting, and anorexia
Acute cholecystitis is an acute inflammation of the gallbladder commonly
manifested by the following: anorexia, nausea, and vomiting; biliary colic;
tenderness and rigidity the right upper quadrant (RUQ) elicited on palpation (e.g.,
Murphys sign); fever; fat intolerance; and signs and symptoms of jaundice.
Ecchymosis, petechiae, and coffee-ground emesis are clinical manifestations of

esophageal bleeding. The coffee-ground appearance indicates old bleeding.

Jaundice, dark urine, and steatorrhea are clinical manifestations of the icteric phase
of hepatitis.
8. Answer: C. Maintenance of nothing-by-mouth status and insertion of
nasogastric (NG) tube with low intermittent suction
With acute pancreatitis, the client is kept on nothing-by-mouth status to inhibit
pancreatic stimulation and secretion of pancreatic enzymes. NG intubation with low
intermittent suction is used to relieve nausea and vomiting, decrease painful
abdominal distention, and remove hydrochloric acid. Vasopressin would be
appropriate for a client diagnosed with bleeding esophageal varices. Paracentesis
and diuretics would be appropriate for a client diagnosed with portal hypertension
and ascites. A low-fat diet and increased fluid intake would further aggravate the
pancreatitis.
9. Answer: B. Breaks down fat into fatty acids and glycerol
Lipase hydrolyses or breaks down fat into fatty acids and glycerol. Lipase is not
involved with the transport of fatty acids into the brush border. Fat itself triggers
cholecystokinin release. Protein breakdown into dipeptides and amino acids is the
function of trypsin, not lipase.
10. Answer: D. Documenting precise intake and output
For the client with ascites receiving diuretic therapy, careful intake and output
measurement is essential for safe diuretic therapy. Diuretics lead to fluid losses,
which if not monitored closely and documented, could place the client at risk for
serious fluid and electrolyte imbalances. Hypokalemia, not hyperkalemia, commonly
occurs with diuretic therapy. Because urine output increases, a client should be
assessed for hypovolemia, not hypervolemia. Weights are also an accurate indicator
of fluid balance. However, for this client, weights should be obtained daily, not
weekly.
11. Answer: A. Passage of two or three soft stools daily
Lactulose reduces serum ammonia levels by inducing catharsis, subsequently
decreasing colonic pH and inhibiting fecal flora from producing ammonia from urea.
Ammonia is removed with the stool. Two or three soft stools daily indicate
effectiveness of the drug. Watery diarrhea indicates overdose. Daily deterioration in
the clients handwriting indicates an increase in the ammonia level and worsening
of hepatic encephalopathy. Frothy, foul-smelling stools indicate steatorrhea, caused
by impaired fat digestion.
12. Answer: C. Jaundice produces pruritus due to impaired bile acid
excretion.

Jaundice is a symptom characterized by increased bilirubin concentration in the

blood. Bile acid excretion is impaired, increasing the bile acids in the skin and
causing pruritus. Jaundice is not associated with pressure ulcer formation. However,
edema and hypoalbuminemia are. Jaundice itself does not impair urea production or
lead to decreased tissue perfusion.
13. Answer: D. Obtaining cooperation and reducing fear
An esophageal tamponade tube would be inserted in critical situations. Typically,
the client is fearful and highly anxious. The nurse therefore explains about the
placement to help obtain the clients cooperation and reduce his fear. This type of
tube is used only short term and is not indicated for home use. The tube is large
and uncomfortable. The client would not be helping to insert the tube. A clients
anxiety should be decreased, not maintained, and depending on the degree of
hemorrhage, the client may not be alert.
14. Answer: B. Counseling to stop alcohol consumption
Chronic pancreatitis typically results from repeated episodes of acute pancreatitis.
More than half of chronic pancreatitis cases are associated with alcoholism.
Counseling to stop alcohol consumption would be the most helpful for the client.
Dietary protein modification is not necessary for chronic pancreatitis. Daily exercise
and liberalizing fluid intake would be helpful but not the most beneficial
intervention.
15. Answer: A, C, D
Hepatic encephalopathy results from an increased ammonia level due to the livers
inability to covert ammonia to urea, which leads to neurologic dysfunction and
possible brain damage. The nurse should monitor the clients neurologic status,
serum ammonia level, and handwriting. Monitoring the clients hemoglobin and
hematocrit levels and insertion of an esophageal tamponade tube address
esophageal bleeding. Keeping fingernails short address jaundice.
16. Answer: B. Applying pressure to injection sites
The client with cirrhosis who has altered clotting is at high risk for hemorrhage.
Prolonged application of pressure to injection or bleeding sites is important.
Complete independence may increase the clients potential for injury, because an
unsupervised client may injure himself and bleed excessively. Antibiotics and good
nutrition are important to promote liver regeneration. However, they are not most
important for a client at high risk for hemorrhage.
17. Answer: C. Hand tremors
Hepatic encephalopathy results from the accumulation of neurotoxins in the blood,
therefore the nurse wants to assess for signs of neurological involvement. Flapping

of the hands (asterixis), changes in mentation, agitation, and confusion are

common. These clients typically have ascites and edema so experience weight gain.
Malaise and stomatitis are not related to neurological involvement.
18. Answer: B, D
Edematous tissue must receive meticulous care to prevent tissue breakdown. Range
of motion exercises preserve joint function but do not prevent skin breakdown.
Abdominal or foot massage will not prevent skin breakdown but must be cleansed
carefully to prevent breaks in skin integrity. The feet should be kept at the level of
heart or higher so Fowlers position should be employed. An air pressure mattress,
careful repositioning can prevent skin breakdown.
19. Answer: B. Adequate bed rest
Treatment of hepatitis consists of bed rest during the acute phase to reduce
metabolic demands on the liver, thus increasing blood supply and cell regeneration.
Forcing fluids, antibiotics, and bland diets are not part of the treatment plan for viral
hepatitis.
20. Answer: B. Hyperkalemia
This is a potassium-sparing diuretic so clients should be monitored closely for
hyperkalemia. Diarrhea, dizziness, and headaches are other more common side
effects. Tachycardia, jaundice, and constipation are not expected side effects of
spironolactone (Aldactone).