Week 3: Practice Quiz - Results

Attempt 1 of Unlimited

Written May 25, 2025 8:16 PM - May 25, 2025 8:22 PM

Attempt Score 7 / 10 - 70 %
Overall Grade (Highest Attempt) 7 / 10 - 70 %

Question 1 0 / 1 point

The nurse is assigned a patient with acute pancreatitis on the day shift. Upon
entering the room, the patient complains of the following: 9/10 abdominal
pain, nausea and vomiting, numbness and tingling to hands, fatigue, and new
bruising in their umbilical area. What is the nurse's priority action?

A) Administer pain medications

B) Conduct a focused abdominal assessment

C) Check the patient's temperature

D) Check patient's pulse and blood pressure

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The correct answer is D. Bruising in the umbilical region (Cullen's Sign) is an
indication of hemorrhage in acute pancreatitis and pulse/blood pressure will
provide information on whether the patient is stable or going into shock. This
is a prioritization question which means each option is important but in this
case you must choose what the nurse does first. In this case we need to use
the ABC's. Airway, breathing, circulation to answer the question.

Question 2 1 / 1 point

Which of the following is a preventive measure for Hepatitis A?

A) Avoid sharing spoons and plates

B) Handwashing

C) Avoid sharing of sharps and needles

D) Avoid direct contact with bloodstained bedding

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B is correct. Hepatitis A is spread through the oral fecal route. Not washing
hands after coming in contact with an infected person's stool, then putting
your hands in your mouth is a common way HAV is spread.

Saliva, blood, and body fluids are not routes of transmission for Hepatitis A.

B is correct.

Question 3 1 / 1 point

Which of the following interventions is appropriate for the client with liver
cirrhosis?

A) Manage mild pain with acetaminophen

B) Place on high sodium diet

C) Manage constipation with laxatives

D) Encourage patient to reduce calories

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A. Acetaminophen should never be administered to a patient with poor liver

function because it is a known hepatotoxin.

B. Patients with liver cirrhosis should be placed on a low sodium diet due to
increased levels of aldosterone in their system. They already experience
sodium and water retention causing edema and ascites.

D. A dysfunctional liver cannot metabolize carbohydrates, fat, and protein

properly. Normally when you eat carbohydrates, the liver can store glucose as
glycogen to be used in between meals. In liver cirrhosis, this does not happen
and the person becomes hypoglycemic. The body will take from muscle and
there will be muscle wasting. Clients should increase their intake of food to
prevent this from happening.

The correct answer here is C: to manage constipation. Hepatic

encephalopathy can occur when ammonia builds up in the blood and
constipation increases intestinal production and absorption of ammonia.

C is correct. Constipation is a trigger for developing hepatic encephalopathy.

Constipation causes ammonia build up in the gut.

Question 4 0 / 1 point

Which of the following is a consequence of bile obstruction:

A) Excessive bruising

B) Flapping tremors (asterixis)

C) Splenomegaly

D) Esophageal varices

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A is correct. Bile is required for the emulsification and absorption of fat.
Vitamin K is a fat soluble vitamin. Without vitamin K, the clotting factors
cannot be activated and coagulation is impaired leading to bruising and
bleeding.

Flapping tremors or asterixis is a result of toxic levels of ammonia in the blood

and brain. This is an assessment finding in hepatic encephalopathy.

Splenomegaly or enlarged spleen and is a consequence of portal

hypertension, not a biliary obstruction. The hardened and scarred liver
creates resistance and blood flow becomes difficult. Hepatic portal vein
pressure increases causing the back up of blood into the spleen.

Esophageal varices are a consequence of portal hypertension and the creation

of collateral vessels.

B is Incorrect.

Question 5 1 / 1 point

While talking to a client with end-stage liver disease, the nurse notices the
client is unable to stay awake and seems to fall asleep mid-sentence. The
nurse recognizes that these symptoms are manifestations of what condition?

A) Hyperglycemia

B) Increased serum bilirubin (hyperbilirubinemia)

C) Increased serum ammonia

D) Hypocalcemia
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Patients with severe liver disease are prone to hypoglycemia because of the
liver's inability to adequately store glucose as glycogen.

Increase serum bilirubin does not cause changes in mentation

Hypocalcemia affects the neuromuscular system but does not usually impact
mentation

C is correct. Ammonia is very toxic to the brain and causes changes in neuro
function.

C is correct.

Question 6 1 / 1 point

A client with advanced cirrhosis asks the nurse why his abdomen is so
swollen. The nurse's response is based on the knowledge of which of the
following?

A) Decreased peristalsis in the GI tract contributes to gas formation

and distension of the bowel.

Portal hypertension and hypoalbuminemia cause a fluid shift into

B)
the peritoneal space

C) Bile salts in the blood irritate the peritoneal membranes, causing

edema and pocketing of fluid.

D) A lack of clotting factors promotes the collection of blood in the

abdominal cavity
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Ascites is due to several factors. The dysfunctional liver is not producing

albumin which is our key plasma protein providing oncotic pressure. Low
serum albumin prevents us from keeping fluid in the intravascular space.
Portal hypertension causes a high pressure and push of fluid into the
tissues/interstitial space. Without albumin, the fluid remains in the interstitial
space.

B is correct.

Question 7 1 / 1 point

A patient comes to the emergency room with severe right upper quadrant
pain. The nurse suspects the patient may be experiencing cholecystitis based
on the following patient data:

A) Male, age 25, increased BMI, university student

B) Female, age 42, 4 children, increased BMI

C) Male, age 62, 2 children, normal weight

D) Female, age 55, increased BMI, no children

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The correct answer is B. Remember the 4 F's for risk factors being female,
fertile, fat/fabulous, forty. This patient has both an increase in cholesterol and
increase in estrogen which changes the content of the bile.

Question 8 1 / 1 point

The nurse is administering lactulose to a patient with hepatic encephalopathy.

Which of the following findings demonstrates effectiveness of the
medication?

A) Increased red blood cells

B) Decreased liver enzymes

C) Increased albumin

D) Decreased ammonia levels

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D is the correct answer. Lactulose is a laxative used to decrease ammonia

levels in the body and is used specifically to improve hepatic encephalopathy.
It will not decrease liver enzymes or correct albumin levels.

Question 9 0 / 1 point
The patient is receiving spironolactone daily. Which of the following
assessment findings indicate the patient is hyperkalemic? Select all that apply:

A) Presence of murmur

B) Heart Rate 55 beats per minute, irregular

C) Increase in energy

D) Muscle weakness

E) Numbness and tingling

F) Excessive Thirst

G) Seizures

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The correct answer is B, D, E. Irregular heart beat, arrhythmias, muscle

weakness, and paresthesia are all symptoms of hyperkalemia. The person
would not have increased energy, they would be fatigued. Seizure and
excessive thirst are signs of high sodium, not high potassium.

Question 10 1 / 1 point

Match the correct drug to the corresponding Desired Effect

 Prevention of esophageal varices
__3__ HSA (Albumin) 1.
bleeds
__4__ Spironolactone
2. Reduction in ammonia levels
__1__ Propranolol
3. Increased intravascular volume
__2__ Lactulose
4. Decrease in edema

Done