Practice Test: Hepatobiliary and Pancreatic Health Problems
Answers and rationales will be posted after 7 days. Feel free to post comments for any typographical or grammatical errors.
Enjoy answering the questions.
Situation 1: Nurse Craig works as a probationary staff nurse at the Bicol Medical Center. During his shift, he was tasked by his head nurse to conduct a health education session about the functions of the hepatobiliary and pancreatic system.
1. Nurse Craig knows that the liver is located at the __________________ of the abdomen.
a. Right Upper Quadrant
b. Left Lower Quadrant
c. Right Lower Quadrant
d. Left Upper Quadrant
2. Bile is synthesized in the liver and transported to the bile ducts via the bile canaliculi. What controls the flow of bile in the duodenum?
a. Cystic duct
b. Sphincter of Oddi
c. Common bile duct
d. Common hepatic duct
3. Gallbladder is a sac like organ located on the inferior surface of the liver. Nurse Craig is aware that the gallbladder’s primary purpose is to:
a. metabolize bilirubin
b. store fat soluble vitamins
c. store and concentrate bile
d. produce bile
4. What hormone promotes the storage and utilization of food primarily glucose and fats?
5. During the session, a client asks Nurse Craig if she can live without her gallbladder. In order to respond to this client, Nurse Craig must have which understanding of the hepatobiliary system?
a. The liver produces about 1000 ml of bile/day
b. The liver concentrates bile more than 10 times
c. The gallbladder makes about 90 ml bile/day
d. The gallbladder dilutes and releases bile
Situation 2: Nurse Nelly is assessing Mr. Shick who is in the early stages of cirrhosis of the liver.
6. Which early sign would Nurse Nelly anticipates finding?
a. Peripheral edema
7. What diet should be implemented for Mr. Shick who is in the early stages of cirrhosis? a. High calorie, high carbohydrate
b. High protein, low fat
c. Low fat, low protein
d. High carbohydrate, low sodium
8. Mr. Shick complains that his skin always feel itchy and that he “scratches himself raw” while he sleeps. Nurse Nelly should recognize that the itching is the result of which abnormality associated with cirrhosis?
a. Folic acid deficiency
b. Prolonged prothrombin time
c. Increased bilirubin level
9. Few days after, Mr. Shick is developing ascites. Nurse Nelly should recognize that the pathologic basis for the development of ascites in clients with cirrhosis is portal hypertension and:
a. an excess serum Na level
b. an increased metabolism of aldosterone
c. a decreased flow of hepatic lymph
d. a decreased serum albumin level
10. Which of the following health promotion activities would be appropriate for Nurse Nelly to suggest to his client add to the daily routine at home?
a. Supplement the diet with multivitamins
b. Limit daily alcohol intake
c. Take a sleeping pill at bedtime
d. Limit contacts with other people
Situation 3: Nurse Rihanna together with her colleagues at San Lazaro Hospital is conducting a community education on how to prevent the transmission of hepatitis.
11. Which of the following types of hepatitis is considered to be primarily a sexually transmitted disease?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
12. Nurse Rihanna knows that during the icteric phase of viral hepatitis, the client will exhibit which of the following symptoms?
a. Tarry stools
b. Yellowed sclera
c. Shortness of breath
d. Light, frothy urine
13. Which of the following precautions would Nurse Rihanna and her colleagues indicate as essential when caring for clients with Hepatitis A?
a. Gowning when entering a client’s room
b. Wearing a mask when providing care
c. Assigning the client in a private room
d. Wearing gloves when giving direct care
14. Nurse Rihanna is developing a teaching plan for a client with Hepatitis A. Which of the following instructions is appropriate?
a. Spray the house to eliminate infected insects
b. Tell family members to try to stay away from the client
c. Tell the family members to wash their hands frequently
d. Disinfect clothing and eating utensils
15. After the community education, a client approached Nurse Rihanna and expressed feelings of isolation as a result of having hepatitis. What would be Nurse Rihanna’s best response?
a. “Don’t Worry. It’s normal to feel that way.”
b. “Your friends are probably afraid of contracting hepatitis from you.”
c. “I’m sure you’re imagining that!”
d. “Tell me more about your feelings of isolation.”
Situation 4: Mrs. Smith, 44 years old is admitted to the hospital complaining of severe abdominal pain and extreme nausea and has vomited several times. A diagnosis of cholecystitis from cholelithiasis was made.
16. Based on the data, which nursing diagnosis would have the highest priority intervention at this time?
a. Anxiety r/t severe abdominal discomfort
b. Fluid Volume Deficit r/t vomiting
c. Pain r/t gallbladder inflammation
d. Imbalanced Nutrition: Less than body requirement r/t vomiting
17. The group of characteristics that would alert Nurse Pharrel that his client has increased risk of developing gall bladder disease would be female:
a. over the age of 40, obese
b. over the age of 40, low cholesterol level
c. under the age of 40, history of high fat intake
d. under the age of 40, family history of gallstone
18. When common bile duct is obstructed, Nurse Pharrel should evaluate her client for signs of which of the following complications?
a. Respiratory distress
b. Circulatory overload
c. Urinary tract infection
d. Prolonged bleeding time
19. Mrs. Smith complained of severe right upper quadrant pain. Which of the following medication would Nurse Pharrel anticipates administering to relieve the client’s pain?
a. Meperidine (Demerol)
b. Acetaminophen with codeine
c. Promethazine (Phernergan)
d. Morphine sulfate
20. A laparoscopic cholecystectomy is scheduled. Which of the following instructions should Nurse Pharrel include in his discharge plan?
a. Avoid showering for 48 hours after surgery
b. Return to work within one week
c. Change the dressing daily until the incision heals
d. Use acetaminophen (Tylenol) to control fever
Situation 5: Capt. Jack Sparrow was admitted in the Medical Floor of The Medical City. The admission history shows an alcohol abuse of excessive intake of liquor for more than 10 years. Laboratory findings result shows high trygyceride levels and hypercalcemia.
21. The initial diagnosis of pancreatitis is confirmed if Capt. Sparrow’s blood work shows a significant elevation in which of the following serum values?
22. Which of the following actions of pancreatic enzymes can cause pancreatic damage?
a. Utilization by the intestine
b. Autodigestion of the pancreas
c. Reflux into the pancreas
d. Clogging of the pancreatic duct
23. The initial treatment plan for Capt. Sparrow most likely would focus on which of the following as a priority?
a. Resting the GIT
b. Ensuring adequate nutrition
c. Maintaining fluid and electrolyte balance
d. Preventing the development of an infection
24. Capt. Sparrow may exhibit Cullen’s sign on physical examination. Nurse Shakira knows that Cullen’s sign can be best described as:
a. Distended tortuous veins in the esophagus
b. Yellow-orange discoloration of the skin
c. Bluish discoloration of the left flank area
d. Bluish discoloration of the periumbilical area
25. In alcohol related pancreatitis, which of the following interventions is the best way to reduce the exacerbation of pain?
a. Lying supine
b. Taking aspirin
c. Eating a low – fat diet
d. Abstaining from alcohol
Situation 6: Nurse Cassie is caring to clients who had undergone surgeries and diagnostic procedures.
26. Nurse Cassie understands that after a cholecystectomy and common bile duct exploration, the client will:
a. need to take oral bile salts
b. be incapable of producing bile
c. be unable to concentrate bile
d. not be able to digest fatty foods
27. Because of prolonged bile drainage from a T – tube, a client may develop symptoms related to a lack of fat soluble vitamins such as:
a. easy bruising
b. excessive jaundice
c. muscle twitching
d. tingling of the fingers
28. Considering both the endocrine and exocrine functions of the pancreas, the client’s postoperative regimen would primarily include managing intake of:
a. alcohol and caffeine
b. fluids and electrolytes
c. vitamins and minerals
d. fats and carbohydrates
29. Nurse Cassie knows that several hours after liver biopsy, the client will remain in what position?
a. Left side lying with head of bed elevated
b. Right side lying with pillows placed under the costal margin
c. High fowler’s with both arms supported on pillows
d. Any comfortable recumbent position as long as the client remains immobile
30. An obese client with a history of gallstone has an abdominal cholecystectomy. After surgery, Nurse Cassie plans to alleviate tension on the surgical wound by:
a. limiting deep breathing
b. maintaining T – tube patency
c. maintaining nasogastric tube patency
d. encouraging the right side lying position
Situation 7: Mr. Gibson, 60 – year old, is admitted to the hospital with cirrhosis. He has history of alcoholism and hepatitis B.
31. What should Nurse Ashanti expect to find on his initial laboratory results?
b. elevated ALT
c. elevated serum albumin
32. Mr. Gibson is scheduled for a liver biopsy. What is your priority of care for this patient? a. monitor for bleeding
b. encouraging increased activity
c. controlling blood pressure
d. providing nutritional support
33. What life threatening complication will result when the liver is destroyed due to hepatitis B and up to the development of chronic hepatitis?
a. portal hypertension
b. esophageal varices
c. liver failure
d. hepatic encephalopathy
34. What instruction about diet modification should Nurse Ashanti give to Mr. Gibson?
a. increase fluid intake
b. avoid canned and processed food
c. eat food reach in protein
d. encourage to eat dairy products and poultry
35. Mr. Gibson asks Nurse Ashanti why he has edema. Nurse Ashanti would use which of the following statements to explain how edema results from pathophysiologic changes in cirrhosis?
a. “The edema occurs because your liver produces fewer proteins that help draw fluid into the bloodstream”
b. “The high osmotic pressure of proteins in your blood pushes fluid into the body tissues”
c. “The kidneys are able to filter less fluid, so the body cannot excrete it as urine very easily”
d. “Your body is metabolizing sex hormones more quickly, leading to fluid retention.
Situation 8: Mrs. Carey, 49-year-old female was rushed in the emergency department because of severe and steady right upper quadrant pain that radiates to the scapula lasting for 2 hours. She has vomited frequently and experiencing chills.
36. Based from the data presented, Mrs. Carey is experiencing which of the following problems?
a. acute pancreatitis
c. acute cholecystitis
d. hepatic encephalopathy
37. Physical exam findings revealed a severe pain in the RUQ with inspiratory arrest. Nurse Beyonce knows, that her client is positive for which of the following signs?
a. Grey Turner’s sign
b. McBurney’s sign
c. Cullen’s sign
d. Murphy’s sign
38. Which of the following tests is most commonly used to diagnose Mrs. Carey’s problem?
a. Abdominal computed tomography scan
b. Abdominal ultrasound
c. Barium swallow
39. Frequent vomiting puts Mrs. Carey at risk of which of the following acid-base imbalance?
a. metabolic acidosis and hyperkalemia
b. metabolic alkalosis and kyperkalemia
c. metabololic acidosis and hypokalemia
d. metabolic alkalosis and hypokalemia
40. When counseling Mrs. Carey in the ways to prevent the exacerbation of the problem, which of the following guidelines is most important?
a. Eat a low protein diet
b. Limit exercise to 10 minutes a day
c. Eat a low – fat diet, cholesterol diet
d. Keep weight proportional to height
Situation 9: Nursing process is a systematic problem solving approach to the collaborative identification of client health needs and the application of nursing care to effectively meet those needs.
41. A client was admitted in the emergency department with exacerbation of cholelithiasis. When does discharge planning begins?
a. after physical examination
b. after initial assessment
c. upon admission
d. before discharge
42. How will you assess a client with hepatic encephalopathy having asterixis?
a. On deep inspiration, pain is elicited and breathing stops
b. On deep palpation and released, pain is elicited
c. Ask client to hold his arms straight in front and flappy hand tremors occur
d. Place hand over the patient's right knee while the patient flexes their right hip against the resistance
43. The client who has acute pancreatitis tells Nurse Juris, “I Just want my gall bladder taken out now.” Nurse Juris best response should be which of the following?
a. “I don’t blame you but they want your pain under control first”
b. “Would you like to ask if your physician will schedule surgery today?”
c. “The symptoms are distressing, bu the surgeon must wait until your gallbladder is less infected”
d. “They will try to dissolve the stones before they do the surgery”
44. Mr. Prefix with cirrhosis was admitted to the hospital. Which of the following assessments made by Nurse Juris would indicate the development of portal hypertension?
b. Elevated blood pressure
45. Ms. Suffix with hepatitis is experiencing fatigue, weakness, and a general feeling of malaise. She tires rapidly during morning care. Based on this information, which of the following would be an appropriate nursing diagnosis?
a. Impaired physical mobility r/t malaise
b. Ineffective individual coping r/t long term illness
c. Self care deficit r/t fatigue
d. Activity intolerance r/t fatigue
Situation 10: Nurse Shaggy is the staff nurse on duty in the Medical Floor. He is caring to clients with hepatobiliary and pancreatic disorders. Health teaching is his primary role for the quick recovery of his clients.
46. Ms. Demeanor has jaundice. Nurse Shaggy’s most appropriate comfort measure to implement is:
a. Offer hot beverages frequently
b. Encourage taking a hot bath or shower
c. Keep the air temperature at approximately 68 to 70 degrees F
d. Suggest the use of alcohol based skin lotion
47. When teaching Mr. Gabrielle with hepatitis A about infection control, Nurse Shaggy explains that he is most infectious to others at which of these times?
a. 7 days exposure
b. 2 months after exposure
c. 10 days before the onset of symptoms
d. 14 days after symptoms begin
48. Which of the following dietary instructions would be appropriate for Nurse Shaggy to give a client who is recovering from acute pancreatitis?
a. Avoid crash dieting
b. Eat six small meals day
c. Restrict carbohydrate intake
d. Decrease sodium in diet
49. Mr. Foxx who has ascites and peripheral edema is at risk for impaired skin integrity. Which of the following intervention would be implemented to prevent skin breakdown?
a. ROM exercises every 4 hours
b. Use of alternating air pressure mattress
c. Massage of the abdomen once a shift
d. Elevation of the lower extremities
50. A male client with liver dysfunction reports that his gums bleed spontaneously. In addition, Nurse Shaggy notes small hemorrhagic lesions on his face. Nurse Shaggy recognizes that the client needs nutritional vitamin:
- end of exam /brewed