(Osborn) Chapter 46: Osborn, Et Al., Test Item File For Medical-Surgical Nursing: Preparation For Practice

[Osborn] chapter 46
Learning Outcomes [Number and Title ]

Learning Outcome 1
Describe the different types of hepatitis viruses and the mode of
transmission for each one.
Learning Outcome 2
Discuss the clinical manifestations of hepatitis.
Learning Outcome 3
Compare and contrast pathophysiology, clinical manifestations,
and treatment with related nursing care of patients with
cirrhosis.
Learning Outcome 4
Outline the nursing care of a patient with hepatic
encephalopathy.
Learning Outcome 5
Delineate nursing care for a patient with liver cancer.
Learning Outcome 6
List the risk factors for gallbladder disease.
Learning Outcome 7
Compare and contrast the nursing care for patients with an
open cholecystectomy and laparoscopic cholecystectomy.
Learning Outcome 8
Analyze the similarities and differences between acute and
chronic pancreatitis.
Learning Outcome 9
Discuss the causes, clinical manifestations, and treatment for
pancreatic cancer.
Learning Outcome 10
Develop a teaching plan for patients with pancreatitis.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. A nurse gives a client with hepatitis A discharge instructions. This client works at a
local pizza restaurant and has been ill for a few days. There have been six more cases of
hepatitis A admitted in the last 2 days. The nurse carefully explains hand-washing
techniques to this client. The nurse recognizes that the most likely way this client could
have infected others is:
1.
2.
3.
4.
Through the fecaloral route at the restaurant.

Through blood contact.
Through sexual contact.
Unable to be determined; the spread of hepatitis A is unknown
Correct Answer: Through the fecaloral route at the restaurant

Rationale: Hepatitis A is most commonly transmitted via the fecaloral route; it can be
transmitted via oral sex and via blood contact, but this is less likely given the clients job
at the restaurant.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
LO: 1
2. A client is admitted to an acute care facility with acute onset of hepatitis B. In an effort
to best determine the route of transmission, the nurse asks which of the following
questions?
1.
2.
3.
4.
Do you use IV drugs?

Do you wash your hands frequently?
Are you married?
Have you been vaccinated against hepatitis B?
Correct Answer: Do you use IV drugs?

Rationale: The nurse needs to determine if the client is an IV drug user. Hepatitis B is
most commonly transmitted via blood and body fluids, but can also be transmitted via
inanimate objects because the virus can live for up to a week on surfaces. Washing hands
is a method of prevention for hepatitis A. Marital status doesnt preclude someone from
being exposed to the virus. There is a vaccine for hepatitis B.
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 1
3. A client is seen in the public health clinic for symptoms of hepatitis. The nurse is
questioning the client regarding exposure. The client provides the following information:
a recent missionary trip to Africa; involved in a monogamous heterosexual relationship
for 25 years; no history of IV drug use; blood transfusions 5 years ago. What is the most
likely type of hepatitis for this client?
1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis G
Correct Answer: Hepatitis A
Rationale: Hepatitis A is found in contaminated water, which may be found in various
locations in Africa the client visited. While the client could be hiding the truth about other
high-risk behaviors, the client does have the one risk factor that is a possibility for
hepatitis A. While the client received blood 5 years ago, this should not be a risk factor
for hepatitis, though it still might be for HIV. There are no risk factors indicated for
hepatitis B, C, or G.
Cognitive Level: Analysis
LO: 1
4. A young client is seen in the public health department for flulike symptoms. The nurse
suspects hepatitis. The nurse knows that the client may likely develop jaundice:
1.
2.
3.
4.
5 to 10 days after the initial flulike symptoms.

2 weeks after exposure.
2 to 3 weeks after getting ill.
Up to 16 weeks after the initial exposure.
Correct Answer: 5 to 10 days after the initial flulike symptoms.

Rationale: The prodromal stage begins 2 weeks after exposure. The icteric stage begins 5
to 10 days after the initial flulike symptoms. This is when the client might develop
jaundice. The convalescent phase begins 2 to 3 weeks after the symptoms begin, and
recovery may take up to 16 weeks.
Nursing Process: Planning
LO: 2
5. A client presents to the emergency department (ED) complaining of poor appetite,

jaundice, low-grade fever, and pain in the right upper quadrant. The nurse is performing
an admission assessment. The nurse recognizes these symptoms as:
1.
2.
3.
4.
Similar for all of the hepatitis viruses.

Hepatitis A.
Hepatitis B.
Hepatitis C.
Correct Answer: Similar for all of the hepatitis viruses.

Rationale: The symptoms for the varying types of hepatitis are all very similar and cannot
be distinguished without lab work.
LO: 2
6. A client is seen in the clinic complaining of fatigue, joint pain, and lack of appetite.
The health care provider (HCP) suspects hepatitis in the prodromal phase based upon the
clients signs and symptoms and history. What other symptoms might the HCP find?
1. Fever
2. Jaundice
3. Severe abdominal pain
4. Dark urine
Correct Answer: Fever
Rationale: Fever is another symptom the HCP may find in the prodromal phase of
hepatitis. Jaundice and dark urine that results from jaundice occur in the icteric phase. In
the prodromal phase, mild constant abdominal pain is sometimes present, but not severe
abdominal pain.
LO: 2
7. A client presents to the emergency department with bleeding esophageal varices. The
nurse also initially assesses the client for which of the following?
1.
2.
3.
4.
Ascites
Hypertension
Cardiac disease
Activity intolerance
Correct Answer: Ascites

Rationale: The clients esophageal varices indicate that the client has portal hypertension,
which is different than typical hypertension. Portal hypertension also causes ascites. The
client may or may not be at risk for cardiac disease. Activity intolerance is likely, but is
not an initial assessment.
LO: 3
8. The nurse notes that the client admitted with cirrhosis is more anxious than usual. The
client has ascites and has had a poor appetite. The client states, I cant breathe. The
nurses most appropriate initial response is to:
1.
2.
3.
4.
Evaluate the respiratory status.

Contact the health care provider.
Assess the abdomen.
Give the client his medication.
Correct Answer: Evaluate the respiratory status.

Rationale: Clients with ascites may have difficulty with breathing due to the size of the
abdomen. Therefore, the initial response is for the nurse to evaluate the respiratory status
of the client. If there is medication ordered that may assist in decreasing the ascites, the
nurse may, after evaluating the respiratory status, choose to give the medication or to
contact the health care provider. Assessing the abdomen will reveal ascites.
LO: 3
9. A client diagnosed with cirrhosis and ascites is receiving discharge instructions. The
nurse is discussing dietary restrictions. The nurse instructs the client to avoid:
1. Cheese.
2. Raw apple.
3. Broccoli.
4. Pasta.
Correct Answer: Cheese.
Rationale: The client with cirrhosis should avoid processed foods, such as cheese, canned
soups, packaged meats, and so forth. This client can eat raw fruit, vegetables, and pasta
because the dietary restrictions will involve sodium and fluids, as well-high protein
foods, particularly as client becomes more advanced.
LO: 3
10. The priority medication for a client who has developed hepatic encephalopathy is:
1.
2.
3.
4.
Lactulose (Chronulac).
Vitamin K (Mephyton).
Diazepam (Valium).
Norfloxacin (Noroxin).
Correct Answer: Lactulose (Chronulac).

Rationale: The client who has developed hepatic encephalopathy will be given lactulose
to help the client excrete excess ammonia levels from the blood into the colon. Vitamin K
and norfloxacin may be given to clients with esophageal varices. The diazepam is not
indicated for a client with hepatic encephalopathy, but rather oxazepam will likely be
given to control agitation because it is not metabolized in the liver.
LO: 4
11. Reflecting upon the clients other symptoms, the nurse determines the client likely has
developed hepatic encephalopathy when the client:
1.
2.
3.
4.
Becomes increasingly agitated, with changes in mentation.

Begins to have bleeding esophageal varices.
Has ascites.
Begins to complain of a significant headache.
Correct Answer: Becomes increasingly agitated with changes in mentation.

Rationale: Clients will exhibit symptoms of changing mentation with possible agitation
as they develop hepatic encephalopathy. Bleeding esophageal varices and ascites only
indicate the client has hepatic portal hypertension. Developing a headache is not
indicative of hepatic encephalopathy.
LO: 4
12. An agitated, confused client with hepatic encephalopathy has just received a dose of
lactulose (Chronulac). The nurse determines this medication has been effective if the
client:
1. Becomes more alert and cooperative.
2. Has one formed stool per day.
3. Is able to breathe better.
4. Asks for less pain medication.
Correct Answer: Becomes more alert and cooperative.
Rationale: Lactulose decreases the ammonia content in the blood. Lactulose is given until
the client has two to three loose stools per day. The hepatic encephalopathy client may
have problems with breathing due to ascites, but lactulose will not impact this. Lactulose
will not impact the amount of pain medication the client requests.
Nursing Process: Evaluation
LO: 4
13. A client is asking the nurse about how individuals get liver cancer. The nurse responds
correctly by stating:
1. The best way to prevent liver cancer is by not drinking alcohol and avoiding
high-risk behaviors that increase the chances of contracting hepatitis B and
C.
2. The best way to prevent liver cancer is to avoid public restaurants, as the
cleanliness of the restaurant or the care that is taken in the food preparation
cannot be predicted.
3. The best way to prevent liver cancer is to catch it early. Liver cancer is easily
detected by physical exam.
4. The best way to prevent liver cancer is to avoid IV drug use. Using IV drugs
has the highest correlation with contracting hepatitis B and C.
Correct Answer: The best way to prevent liver cancer is by not drinking alcohol, not
smoking, and avoiding high-risk behaviors that increase the chances of contracting
hepatitis B and C.
Rationale: Avoiding smoking, alcohol, hepatitis B and C, and other known toxins that can
cause liver cancer best prevents liver cancer. Avoiding public restaurants will not
eliminate exposure to liver-cancer-causing agents, since hepatitis A is more commonly
transmitted at restaurants. Liver cancer, caught early, may help increase the odds of
survival, but is not a prevention method. It is also not easily detected by physical exam at
an early stage. Avoiding IV drug use is only one method of diminishing the risk factors
for liver cancer, and is not inclusive.
LO: 5
14. A client with liver cancer has been admitted to hospice. The client asks why he
developed this disease. The nurse knows there is a high likelihood this client has which of
the following past medical histories?
1. Alcohol consumption
2. Sexually transmitted diseases
3. H. pylori
4. Frequent nausea and vomiting
Correct Answer: Alcohol consumption
Rationale: This client has most likely had a past history of alcohol consumption, heavy
smoking, hepatitis B or C, or anabolic steroids. There is no correlation between sexually
transmitted disease, frequent nausea and vomiting, or the presence of H. pylori. However,
H. pylori can cause more problems with hepatic encephalopathy.
LO: 5
15. The nurse is preparing a client with liver cancer for end of life. The nurse knows the
goal of treatment in this case is to:
1.
2.
3.
4.
Make the client as comfortable as possible.

Provide as much medication as possible.
Teach the client how to manage the illness.
Understand the familys wishes.
Correct Answer: Make the client as comfortable as possible.

Rationale: The goal for the end of life is to make the client with end-stage liver disease as
comfortable as possible. Providing medication, teaching the client how to manage the
illness, and understanding the familys wishes are not applicable.
Client Need: Psychosocial Integrity
LO: 5
16. A 32-year-old female with a BMI of 40 is pregnant and has been having abdominal
pain with nausea and vomiting. The nurse is educating the client on the risk factors for
gallbladder disease. The client has which of the following risk factors for gallbladder
disease?
1.
2.
3.
4.
Female, obesity, high estrogen state

Female, obesity
Obesity, age, symptoms
Age, high estrogen state
Correct Answer: Female, obesity, high estrogen state

Rationale: Females have gallbladder disease more commonly than men. Obesity and high
estrogen states (pregnancy is an example) increase the risk factor for gallbladder disease.
Other risk factors include certain ethnic groups, certain medications, diabetes, Crohns
disease, cirrhosis, and recent weight loss.
LO: 6
17. A client is female with gallbladder disease symptoms. The nurse knows this client is
at higher risk for the disease because:
1. The female hormones increase the secretion of cholesterol and biliary stasis.
2. The male hormones interfere with the production of bile.
3. The female hormones increase the clients body weight, which decreases the
production of bile.
4. Females tend to take more medications than males, and medications increase
cholesterol production that causes biliary stasis.
Correct Answer: The female hormones increase the secretion of cholesterol and biliary
stasis.
Rationale: The current belief is that estrogen increases the secretion of cholesterol and
progesterone causes an increase in biliary stasis.
Nursing Process: Planning
LO: 6
18. A nurse is teaching a client about the modifiable risk factors for gallbladder disease.
The nurse determines that the client understands the teaching when the client states which
of the following?
1. I will lose no more than 2 pounds per week and will exercise more.
2. I will quit taking my birth control pills.
3. My estrogen replacement pills should help prevent gallbladder disease.
4. Thankfully, my diabetes is not related to gallbladder disease.
Correct Answer: I will lose no more than 2 pounds per week and will exercise more.
Rationale: Rapid weight loss is associated with gallbladder disease, so the client should
be advised to lose weight at a pace of 2 pounds per week. Exercise helps to diminish the
risk factors, such as obesity and high lipid levels. Persons taking birth control pills and
estrogen replacement (hormone replacement) have a higher risk factor associated with
gallbladder disease. Diabetes, Crohns disease, and cirrhosis are associated with a higher
incidence of gallbladder disease.
LO: 6
19. A client with a laparoscopic cholecystectomy is complaining postoperatively of

shoulder pain and is asking if the surgical team incorrectly positioned the client when in
surgery. The nursing diagnosis for this client is Comfort: Readiness for Enhanced. A
nursing intervention that is appropriate for this client is:
1. Provide a warm pack to the shoulder and ambulate the client, progressing to
the clients prior activity level.
2. Provide pain medication for breakthrough pain unrelieved by the PCA
morphine.
3. Provide an antiemetic as ordered.
4. Examine the abdomen for sign of peritonitis.
Correct Answer: Provide a warm pack to the shoulder and ambulate the client,
progressing to the clients prior activity level.
Rationale: Shoulder pain postoperatively following a laparoscopic procedure is often a
result of the gases instilled into the abdomen. Utilizing a warm moist pack and
ambulating the client will assist in reducing this complaint. Most clients do not require
breakthrough pain medication on top of the PCA, as the client can regulate the pain
medicine. Providing an antiemetic will not be beneficial because the client is not
complaining of nausea. There is no indication of peritonitis.
LO: 7
20. The client who is scheduled for an open cholecystectomy is questioning why she must
have an open surgery. The health care provider has already obtained informed consent
from this client. The nurse responds with:
1. There are cases where an open surgery is more beneficial to the client, such
as an infected gallbladder or the need to explore the common bile duct. I can
have your health care provider talk with you again if you have more specific
questions.
2. Not everyone will qualify for a laparoscopic procedure due to their size. I
will call your health care provider and tell her you want a laparoscopic
procedure.
3. Some clients are not good candidates for laparoscopic procedures because
they are afraid of anesthesia.
4. The health care provider needs to discuss this with you. I dont know why
one surgery is chosen over another.
Correct Answer: There are cases where an open surgery is more beneficial to the client,
such as an infected gallbladder or the need to explore the common bile duct. I can have
your health care provider talk with you again if you have more specific questions.
Rationale: The surgeon determines whether a laparoscopic procedure is workable for
each client. This decision is based upon many factors, including prior surgeries, infection
of the gallbladder, the need to explore the common bile duct, and so on. Laparoscopic
clients generally heal quicker, with fewer postoperative complications.
LO: 7
21. A client is scheduled for a laparoscopic cholecystectomy. The health care provider
has indicated that there is a chance that the procedure may need to be done as an open
cholecystectomy. The nurse knows that if the client has an open procedure, which of
the following is more likely?
1. The client may have a T Tube that will allow drainage of bile.
2. The client may have an increase in bowel movements.
3. The client may experience faster recovery.
4. The client may notice more fatty food intolerance.
Correct Answer: The client may have a T Tube that will allow drainage of bile.
Rationale: An open cholecystectomy may require a T Tube inserted if the common
bile duct is explored. There should be no increase in bowel movements. The recovery
time is actually longer with an open procedure. There is no more fatty food
intolerance with one type of procedure over another.
LO: 7
22. A client has been admitted with acute pancreatitis and has a nasogastric tube. The
client is NPO and has not eaten in several days. The client has been in pain and on bed
rest. The client tells the nurse, I dont understand why I cant eat. The nurse responds
by:
1. Explaining the purpose of the nasogastric tube and the reasons for keeping the
client NPO.
2. Asking the client if pain medication is needed.
3. Telling the client that pain medication is limited to prevent addiction.
4. Providing the client food.
Correct Answer: Explaining the purpose of the nasogastric tube and the reasons for
keeping the client NPO.
Rationale: The client must understand the purpose of the treatment plan. Providing an
understanding of the need for being NPO is important. Pain medication addiction is more
likely in chronic pancreatitis than in acute. The client will need to remain NPO to allow
the pancreas to rest.
LO: 8
23. A client with chronic pancreatitis is taking pancreatic enzymes. The client
understands the client teaching when the client states:
1.
2.
3.
4.
I will take this medication with food.

I should take this medication on an empty stomach.
I take this medication only when my stomach is hurting.
This medication is monitored by the lab work.
Correct Answer: I will take this medication with food.

Rationale: Pancreatic enzymes need to be taken with food and on a regular schedule, not
just when the client is experiencing symptoms. There are no particular labs that are done
to monitor pancreatic enzymes.
LO: 8
24. A client is admitted with acute pancreatitis. The nurse recognizes the clients
nutritional outcomes have been met when the client exhibits which of the following?
1.
2.
3.
4.
Clients weight has increased 0.5 pounds over 1 week.

Clients weight has decreased 2 pounds over 1 week.
Clients weight has decreased 2 pounds over the past day.
Clients weight has increased 1 pound over the past day.
Correct Answer: Clients weight has increased 0.5 pounds over 1 week.
Rationale: The overall nutritional outcome for this client is to not lose weight. Nutritional
status is reflected over 1 week, whereas fluid status is reflected from day to day. Thus, the
clients weight gain of 0.5 pound over 1 week meets the outcomes for this goal, whereas
the 2-pound loss over 1 week reflects a net nutritional loss. The weight decreasing 2
pounds and increasing 1 pound over the past day indicates fluid loss and gain,
respectively.
LO: 8
25. A nurse is caring for a client with pancreatic cancer. The nurse closely monitors the
client for jaundice, knowing that which of the following assessments closely correlates
with jaundice?
1.
2.
3.
4.
Pruritus
Nausea
Pain
Vision disturbances
Correct Answer: Pruritus

Rationale: Pruritus usually accompanies jaundice. Therefore, the client may also require
care for itching so the client does not damage the skin. Nausea may accompany
pancreatic cancer, but is not necessarily associated with jaundice. Pain and vision
disturbances do not accompany jaundice.
LO: 9
26. Often a client with pancreatic cancer tends to lose weight due to the inability of the
body to absorb nutrients. The nurse instructs the client to be alert to which of the
following that may indicate malabsorption?
1.
2.
3.
4.
Steatorrhea
Vomiting
Pain
Jaundice
Correct Answer: Steatorrhea

Rationale: Steatorrhea is loose, fatty, foul-smelling stools caused from the lack of the
enzyme lipase. Lipase is needed to digest fats. Vomiting, pain, and jaundice do not
necessarily indicate malabsorption.
LO: 9
27. A client with end-stage pancreatic cancer is admitted to the nursing unit. The client is
lethargic and jaundiced. A priority goal for this client will be to:
1. Manage comfort.
2. Understand effects of high bilirubin levels.
3. Manage nutrition.
4. Increase activity.
Correct Answer: Manage comfort.
Rationale: A client with end-stage pancreatic cancer who is lethargic and jaundiced will
need comfort managed and will receive palliative care. Managing nutrition and
understanding the effects of high bilirubin levels may be important for this client, but it
depends upon the extent of the lethargy and the clients wishes for aggressive treatment
options. Increased activity would not be practical for this client.
LO: 9
28. A nurse is assigned to care for a client with pancreatitis. The nurse teaches the client
to assess which of the following parameters on a daily basis?
1.
2.
3.
4.
Weight
Blood pressure
Pulse
Sclera
Correct Answer: Weight

Rationale: The client checks daily weights. Changes from day to day reflect fluid status,
but changes over a weeks time indicate nutritional status. The pancreatic client is at risk
for malabsorption, and nutritional status should be monitored.
LO: 10
29. A nurse is preparing a client with pancreatitis to be discharged to home. The nurse is
instructing the client on decreasing pancreatic stimulation. One method to decrease
pancreatic secretion is to:
1.
2.
3.
4.
Avoid the smell of food.

Increase household noise and stimulation.
Minimize exposure to light.
Stay in an upright position.
Correct Answer: Avoid the smell of food.

Rationale: The smell of food helps to stimulate pancreatic secretions. Limiting the
opportunity to smell food will help the client reduce pancreatic secretions. Minimizing
other stimulations, such as household noise and activity, will also reduce pancreatic
secretions. Staying in an upright position will not affect pancreatic stimulation.
LO: 10
30. A client arrives at the clinic for follow-up care for pancreatitis. This client was
discharged from an acute care facility 4 days ago. The client has been an alcoholic, which
contributed to the pancreatitis. What is the priority intervention for this client?
1. Provide information for Alcoholics Anonymous.
2. Provide teaching about dietary needs.
3. Provide initial instruction on medication.
4. Remind the client of the potential for jaundice.
Correct Answer: Provide information for Alcoholics Anonymous.
Rationale: This client will need continuing support for the alcohol problem. Providing
information regarding Alcoholics Anonymous will be a priority intervention 4 days after
discharge. The other answer choices will have occurred upon discharge from the hospital,
and though reinforcement instructions may be needed, they will not be the highest
priority.
LO: 10

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[Osborn] chapter 46

Learning Outcomes [Number and Title ]

Through the fecaloral route at the restaurant.

Correct Answer: Through the fecaloral route at the restaurant

Do you use IV drugs?

Correct Answer: Do you use IV drugs?

5 to 10 days after the initial flulike symptoms.

Correct Answer: 5 to 10 days after the initial flulike symptoms.

5. A client presents to the emergency department (ED) complaining of poor appetite,

Similar for all of the hepatitis viruses.

Correct Answer: Similar for all of the hepatitis viruses.

Correct Answer: Ascites

Evaluate the respiratory status.

Correct Answer: Evaluate the respiratory status.

Correct Answer: Lactulose (Chronulac).

Becomes increasingly agitated, with changes in mentation.

Correct Answer: Becomes increasingly agitated with changes in mentation.

Make the client as comfortable as possible.

Correct Answer: Make the client as comfortable as possible.

Female, obesity, high estrogen state

Correct Answer: Female, obesity, high estrogen state

19. A client with a laparoscopic cholecystectomy is complaining postoperatively of

I will take this medication with food.

Correct Answer: I will take this medication with food.

Clients weight has increased 0.5 pounds over 1 week.

Correct Answer: Pruritus

Correct Answer: Steatorrhea

Correct Answer: Weight

Avoid the smell of food.

Correct Answer: Avoid the smell of food.

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