Unit 3 Metabolic

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Unit 3 Metabolic EliminationEvolve Website
Review
2
Unit 3 Metabolic EliminationEvolve Chap 37
3

• Which of the following describes the function of
  the kidneys?
• A. Maintain electrolyte and acid-base balance
• B. Regulate body fluid
• C. Remove toxic substances
• D. All of the above are correct.

4

• D. All of the above are correct.

5

• The clinical evidence of rhabdomyolysis is
• A. vomiting.
• B. muscle hypertrophy.
• C. 98.6 F body temperature.
• D. None of the above are correct.

6

• A. vomiting.

7

• Which of the following are types of renal injury
  caused by nephrotoxins?
• A. Acute tubular necrosis
• B. Vasculitis
• C. Proteinuria
• D. Both a and b

8

• D. Both a and b

9

• Acute pyelonephritis, septicemia, drug toxicity,
  and hypercalcemia are potential causes of which
  renal disease?
• A. Tubulointerstitial disease
• B. Glomerulonephritis
• C. Nephritic syndrome
• D. Nephrotic syndrome

10

• A. Tubulointerstitial disease

11

• Which organism usually causes acute
  glomerulonephritis?
• A. Gram-positive bacilli
• B. Beta-hemolytic streptococci
• C. Alpha-hemolytic streptococci
• D. Gram-negative diplococci

12

• B. Beta-hemolytic streptococci

13

• Which of the following diets is ordered for the
  client with acute glomerulonephritis?
• A. High sodium
• B. Low calorie, high protein
• C. High calorie, low protein
• D. High fat

14

• C. High calorie, low protein

15

• If a client has an oxalate renal stone, which of
  the following should be avoided?
• A. Water
• B. Cola drinks
• C. Cheese
• D. Milk

16

• C. Cheese

17

• One of the most common extrarenal diseases
  affecting the kidneys is ____ ____.

18

• diabetes mellitus

19

• The most common pathologic change that leads to
  renal failure in diabetic clients is ____.

20

• glomerulosclerosis

21

• ____ is a disorder usually associated with
  traumatic injury of skeletal muscle tissue, which
  releases myoglobin and intracellular substances
  into the blood.

22

• Rhabdomyolysis

23

• ____ disease can affect the renal circulation and
  cause infarction of the tissue supplied by the
  affected blood vessel.

24

• Thromboembolic

25

• The condition that may affect kidney function
  either through its effect on the systemic
  circulation or by stimulating the immune system
  is ____ ____.

26

• extrarenal sepsis

27

• ___ ___ is a set of clinical manifestations
  caused by protein wasting secondary to diffuse
  glomerular damage.

28

• Nephrotic syndrome

29

• The _____ _____ is a process in which the kidney
  is immersed in iced saline slush, slowing the
  metabolism of the renal tissue.

30

• slush technique

31

• Surgical treatment of the ischemic kidney
  involves clearing the vessel with a balloon
  catheter this technique is known as _____ _____
  _____ _____.

32

• percutaneous transluminal renal angioplasty

33

• ___ is an immunologic, inflammatory, and
  proliferative glomerular changes

34

• Glomerulonephritis

35

• In ___ ___ serous-, blood-, or urine-filled
  grapelike cysts replace kidney tissue

36

• Polycystic kidney

37

• Inflammation of the kidney caused by bacteria is
  known as ___

38

• Pyelonephritis

39

• ___ ___ are stones formed in the kidneys

40

• Renal calculi

41

• ___ ___ ___ is progressive reduction of kidney
  function

42

• Chronic renal failure

43

• Abrupt loss of kidney function is known as ___
  ___ ___

44

• Acute renal failure

45

• ___ ___ is protein wasting secondary to diffuse
  glomerular damage caused by numerous etiologies

46

• Nephrotic syndrome

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Unit 3 Metabolic EliminationEvolve Chap 38
48

• Mr. Carlson exhibits an elevated potassium level.
  The nurse must be alert for which emergency?
• A. Hemorrhage
• B. Pulmonary edema
• C. Circulatory collapse
• D. Cardiac arrest

49

• D. Cardiac arrest

50

• Mr. Carlsons CAT scan revealed a dissecting
  abdominal aneurysm and he is scheduled for
  surgery immediately. Select the reason for Mr.
  Carlson developing acute renal failure (ARF)
  postoperatively.
• A. Clamping of the aorta causing blockage of
  blood to the lower extremities.
• B. Decrease in renal perfusion resulting from
  surgical clamps and hypovolemia.
• C. Increased renal perfusion related to receiving
  multiple blood products.
• D. Retention of urine due to decreased fluid
  intake.

51

• B. Decrease in renal perfusion resulting from
  surgical clamps and hypovolemia.

52

• Mr. Carlsons family asks why he has become
  increasingly confused. The nurse explains that
  acute renal failure (ARF) causes confusion by
• A. sodium and water retention.
• B. retention of abnormal waste products.
• C. increasing the circulating blood volume.
• D. suppressing the immune response.

53

• B. retention of abnormal waste products.

54

• Following Mr. Carlsons dialysis, the nurse must
  assess the arterio-venous fistula for patency.
  The nurse
• A. palpates for both a thrill and a bruit.
• B. auscultates for both a thrill and a bruit.
• C. palpates for a thrill and auscultates for a
  bruit.
• D. auscultates for a thrill and palpates for a
  bruit.

55

• C. palpates for a thrill and auscultates for a
  bruit.

56

• Complications associated with acute renal failure
  include
• A. potential bleeding and clot formation from
  dialysis.
• B. hypotension and autoimmune disorders.
• C. hypoplasia and dysplasia of the kidney.
• D. hydronephrosis and renal calculi.

57

• A. potential bleeding and clot formation from
  dialysis.

58

• Dietary modifications for the client with acute
  renal failure include
• A. fluids equal to urine output plus 1000 ml/day.
  
• B. sodium, potassium, and protein restrictions.
• C. calcium and phosphorus restrictions.
• D. vitamin supplements with added A, D, E, and K.

59

• B. sodium, potassium, and protein restrictions.

60

• When a nurse assesses a client who is receiving
  peritoneal dialysis, which assessment requires
  immediate action?
• A. Return of dialysate that is clear and 50 ml
  less than volume instilled.
• B. Return of dialysate that is clear yellow and
  50 ml more volume than instilled.
• C. Return of dialysate that is cloudy and equal
  to volume instilled.
• D. Dwell time that has exceeded the time allotted
  by 2 hours.

61

• C. Return of dialysate that is cloudy and equal
  to volume instilled.

62

• Select the true statement concerning the
  creatinine clearance test. It
• A. is influenced by many factors such as
  hemorrhage and diet.
• B. is the most accurate test to determine renal
  function.
• C. measures bone demineralization caused by renal
  failure.
• D. measures muscle mass waste products of protein
  metabolism.

63

• B. is the most accurate test to determine renal
  function.

64

• Which of the following is the primary cause of
  end-stage renal disease?
• A. Chronic glomerulonephritis
• B. Heart failure
• C. Diabetes mellitus
• D. Acute pyelonephritis

65

• A. Chronic glomerulonephritis

66

• Which of the following is considered a prerenal
  cause of acute renal failure?
• A. Obstruction of the urinary tract
• B. Increased vascular resistance
• C. Trauma to the kidneys
• D. Glomerulonephritis

67

• B. Increased vascular resistance

68

• Which of the following is a common cause of
  chronic renal failure?
• A. Diabetes
• B. Heart failure
• C. Hypotension
• D. Repeated bouts of cystitis

69

• A. Diabetes

70

• Which of the following drugs is administered to
  reduce the clients phosphorus level?
• A. Calcium gluconate
• B. Sorbitol
• C. Calcium lactate
• D. Aluminum hydroxide

71

• D. Aluminum hydroxide

72

• The most common intrarenal cause of acute renal
  failure is ____ ____ ____.

73

• acute tubular necrosis

74

• The kidneys depend on adequate delivery of blood
  to be filtered by the ____.

75

• glomureli

76

• _____ _____ is the sudden onset of bilateral
  blindness, which seems to be reversed in hours to
  days.

77

• Uremic amaurosis

78

• The most common types of peritoneal dialysis are
  ____, ____, and ____.

79

• continuous ambulatory automated

80

• If the dialysate white blood cell count exceeds
  100 mm3 and neutrophils are greater than 50, the
  client is diagnosed with _____.

81

• perotinitis

82

• _____ is used for clients with acute or
  irreversible renal failure and fluid and
  electrolyte imbalances.

83

• Hemodialysis

84

• ___ ___ leads to impaired insulin production and
  metabolism

85

• Carbohydrate intolerance

86

• In ___ ___ the kidneys are unable to excrete
  hydrogen ions

87

• Metabolic acidosis

88

• Hyperphosphatemia rises inversely with ___

89

• calcium

90

• If the kidneys are unable to excrete protein
  waste products then an ___ ___ ___ level results

91

• elevated serum creatinine

92

• Salt and water retention will lead to ___

93

• Hypernatremia

94

• ___ is a response to high glucose and insulin
  levels

95

• Hyperlipidemia

96

• Salt-wasting effect, vomiting, and diarrhea will
  lead to ___

97

• Hyponatremia

98

• Peptic ulcer disease leads to increased secretion
  of ___ ___

99

• gastric acid

100

• Pericarditis may be caused by an accumulation of
  ___ toxins

101

• uremic

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Unit 3 Metabolic EliminationEvolve Chap 48
103

• What is the major cause of acute pancreatitis in
  the United States?
• A. Geographic location
• B. Nutrition
• C. Alcohol abuse
• D. Age

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• C. Alcohol abuse

105

• Where does pain normally begin with a client with
  acute pancreatitis?
• A. Upper epigastrium
• B. Mid-epigastrium
• C. Lower epigastrium
• D. Lower colon

106

• B. Mid-epigastrium

107

• Severe hemorrhagic pancreatitis may produce what
  two distinctive manifestations?
• A. Bluish discoloration of the left flank and
  periumbilical area
• B. Reddish discoloration of the left flank and
  periumbilical area
• C. Bluish discoloration of the right flank and
  periumbilical area
• D. Reddish discoloration of the right flank and
  periumbilical area

108

• A. Bluish discoloration of the left flank and
  periumbilical area

109

• When do clients with gallstone-associated
  pancreatitis typically experience pain?
• A. Before a meal
• B. After ingesting a large meal
• C. During a meal
• D. After drinking large amounts of liquids

110

• B. After ingesting a large meal

111

• What is one of the most specific indicators of
  acute pancreatitis?

112

• Amylase-creatinine clearance ratio

113

• What medical management procedure is used to
  reduce pain in clients with pancreatitis?
• A. Morphine
• B. Opioid analgesics
• C. Meperidine
• D. Both b and c

114

• D. Both b and c

115

• Which of the following is not a major goal of
  surgical intervention for chronic pancreatitis?
• A. Denervation procedure
• B. Ductal drainage procedure
• C. Pancreatic enzyme replacement
• D. Ampullar procedure

116

• C. Pancreatic enzyme replacement

117

• What hereditary disease is characterized by
  abnormal secretions of the exocrine glands?
• A. Cystic fibrosis
• B. Muscular dystrophy
• C. Multiple sclerosis
• D. Huntington's disease

118

• A. Cystic fibrosis

119

• All of the following are disorders of gallstones
  except
• A. hypertension.
• B. congenital malformations.
• C. infection.
• D. tumors.

120

• A. hypertension.

121

• What are the two most common conditions of
  biliary tract disorder?
• A. Gallstones and associated pancreatitis
• B. Gallstones and associated cholecystitis
• C. Gallstones and associated cholelithiasis
• D. Gallstones and associated cholangitis

122

• B. Gallstones and associated cholecystitis

123

• What type of gallstone may be a combination of
  cholesterol and pigment stones?
• A. Cholesterol stones
• B. Pigment stones
• C. Mixed stones
• D. Combination stones

124

• C. Mixed stones

125

• Which of the following is a factor involved in
  gallstone formation?
• A. Bile is supersaturated with cholesterol or
  calcium.
• B. Solute must precipitate from solution to solid
  crystals.
• C. Crystals must come together and fuse to form
  stones.
• D. All of the above are correct.

126

• D. All of the above are correct.

127

• What is the treatment of choice for symptomatic
  gallbladder disease?
• A. Laser therapy
• B. Surgery
• C. Laparoscopic cholecystectomy
• D. All of the above are correct.

128

• C. Laparoscopic cholecystectomy

129

• Assessment data for chronic cholecystitis are
  similar to acute cholecystitis except
• A. the pain is less severe.
• B. the temperature is higher.
• C. the leukocyte count is higher.
• D. All of the above are correct.

130

• A. the pain is less severe.

131

• Based on the information listed above, what data
  would be considered risk factors for gallbladder
  disease?
• A. Race, gender, and number of pregnancies
• B. Age, hormone replacement, and weight
• C. Hypertension, gender, and race
• D. Hysterectomy, number of pregnancies, and weight

132

• B. Age, hormone replacement, and weight

133

• Ms. D is scheduled for a cholecystectomy and
  common bile duct exploration. In completing
  preoperative teaching, the nurse would include
  which of the following explanations?
• A. Information about a midabdomen vertical
  incision
• B. Information on extracorporeal shock wave
  therapy to break up the gallstones
• C. A description of a T-tube
• D. Information about taking insulin
  postoperatively

134

• C. A description of a T-tube

135

• If Ms. D had an elevated bilirubin level, the
  most likely explanation would be a stone blocking
  the
• A. common bile duct.
• B. gallbladder.
• C. ampulla of Vater.
• D. cystic duct.

136

• A. common bile duct.

137

• Preoperatively, the physician will more likely
  order meperidine (Demerol) than morphine to treat
  Ms. D's pain because
• A. Demerol is a stronger opioid.
• B. morphine has more respiratory effects.
• C. morphine can increase spasms of the sphincter
  of Oddi.
• D. only Demerol can be given intravenously.

138

• C. morphine can increase spasms of the sphincter
  of Oddi.

139

• Postoperatively, if Ms. D were to have a T-tube,
  nursing care plans would include which of the
  following?
• A. Hang the drainage bag below the bed.
• B. Report the first day's output of 500 ml to the
  physician.
• C. Irrigate the T-tube every 4 hours.
• D. Record the volume and color of the drainage
  every 8 hours.

140

• D. Record the volume and color of the drainage
  every 8 hours.

141

• _____ _____ is an inflammation of the pancreas
  that can result in autodigestion of the pancreas
  by its own enzymes.

142

• Acute pancreatitis

143

• The most widely used test for the diagnosis of
  pancreatitis is ____ ____ ____.

144

• serum amylase analysis

145

• ____ ____ involves progressive fibrosis and
  degeneration of the pancreas.

146

• Chronic pancreatitis

147

• The most common neoplasm that affects the
  pancreas is _____.

148

• cancer

149

• The procedure of choice for symptomatic
  cholelithiasis is ____.

150

• lithotripsy

151

• Shock and confusion, coma, or other central
  nervous system manifestations signal the presence
  of ____ ____ ____, a condition in which infected
  bile or pus is under pressure within the duct
  system.

152

• acute toxic cholangitis

153

• ____ ____ is an uncommon inflammatory disease of
  the bile ducts that causes fibrosis and
  thickening of their walls and multiple, short,
  concentric strictures.

154

• Sclerosing cholangitis

155

• X-ray examination of the bile ducts is known as
  ___

156

• Cholangiography

157

• Presence of gallstones is known as ___

158

• Cholelithiasis

159

• Inflammation of the gallbladder without stones is
  known as ___

160

• Acalculous cholecystitis

161

• X-ray examination of the gallbladder is known as
  ___

162

• Cholecystography

163

• Incision and drainage of the gallbladder is known
  as ___

164

• Cholecystostomy

165

• Endoscopic retrograde cholangiopancreatography
  is known as ___

166

• ERCP

167

• Exploration of the common bile duct is known as
  ___

168

• Choledochostomy

169

• ___ ___ is an oral agent that dissolves stones

170

• Ursodeoxycholic acid

171

• Stones in the common bile duct are known as ___

172

• Choledocholithiasis

173

• Cessation of breathing on inspiration and extreme
  pain is known as ___ sign

174

• Murphys

175

• inflammation of the gallbladder is known as ___

176

• Cholecystitis

177

• ___ disease is defined as a pancreaticoduodenal
  resection

178

• Whipples

179

• ___ is the use of shock waves to crush
  gallbladder stones

180

• Lithotripsy

181

• Match the following disorder with the disorder of
  similar manifestations Angina pectoris.
• A. Acute cholecystitis
• B. Chronic cholecystitis

182

• B. Chronic cholecystitis

183

• Match the following disorder with the disorder of
  similar manifestations Renal calculus.
• A. Acute cholecystitis
• B. Chronic cholecystitis

184

• A. Acute cholecystitis

185

• Match the following disorder with the disorder of
  similar manifestations Right lower lobe
  pneumonia.
• A. Acute cholecystitis
• B. Chronic cholecystitis

186

• A. Acute cholecystitis

187

• Match the following disorder with the disorder of
  similar manifestations Hiatal hernia.
• A. Acute cholecystitis
• B. Chronic cholecystitis

188

• B. Chronic cholecystitis

189

• Match the following disorder with the disorder of
  similar manifestations Esophagitis.
• A. Acute cholecystitis
• B. Chronic cholecystitis

190

• B. Chronic cholecystitis

191

• Match the following disorder with the disorder of
  similar manifestations Acute myocardial
  infarction.
• A. Acute cholecystitis
• B. Chronic cholecystitis

192

• A. Acute cholecystitis

193

• Match the following disorder with the disorder of
  similar manifestations Acute pancreatitis.
• A. Acute cholecystitis
• B. Chronic cholecystitis

194

• A. Acute cholecystitis

195

• Match the following disorder with the disorder of
  similar manifestations Acute pyelonephritis.
• A. Acute cholecystitis
• B. Chronic cholecystitis

196

• A. Acute cholecystitis

197

• Match the following disorder with the disorder of
  similar manifestations Peptic ulcer.
• A. Acute cholecystitis
• B. Chronic cholecystitis

198

• B. Chronic cholecystitis

199

• Match the following disorder with the disorder of
  similar manifestations Pyelonephritis.
• A. Acute cholecystitis
• B. Chronic cholecystitis

200

• B. Chronic cholecystitis

201

• Match the following disorder with the disorder of
  similar manifestations Pleurisy.
• A. Acute cholecystitis
• B. Chronic cholecystitis

202

• A. Acute cholecystitis

203

• Match the following disorder with the disorder of
  similar manifestations Intestinal obstruction.
• A. Acute cholecystitis
• B. Chronic cholecystitis

204

• A. Acute cholecystitis

205

• Match the following disorder with the disorder of
  similar manifestations Acute hepatitis.
• A. Acute cholecystitis
• B. Chronic cholecystitis

206

• A. Acute cholecystitis

207

• Match the following disorder with the disorder of
  similar manifestations Acute appendicitis.
• A. Acute cholecystitis
• B. Chronic cholecystitis

208

• A. Acute cholecystitis

209

• Match the following disorder with the disorder of
  similar manifestations Spastic colitis.
• A. Acute cholecystitis
• B. Chronic cholecystitis

210

• B. Chronic cholecystitis

211

• Match the following disorder with the disorder of
  similar manifestations Chronic pancreatitis.
• A. Acute cholecystitis
• B. Chronic cholecystitis

212

• B. Chronic cholecystitis

213

• Match the following disorder with the disorder of
  similar manifestations Intercostal neuritis.
• A. Acute cholecystitis
• B. Chronic cholecystitis

214

• A. Acute cholecystitis

215

• Match the following disorder with the disorder of
  similar manifestations Perforated ulcer.
• A. Acute cholecystitis
• B. Chronic cholecystitis

216

• A. Acute cholecystitis

217
Unit 3 Metabolic EliminationEvolve Chap 49
218

• Mr. James is receiving the medication famotidine
  (Pepcid). Select the rationale for receiving this
  drug. Pepcid
• A. increases esophageal motility.
• B. neutralizes gastric and esophageal acid.
• C. inhibits gastric acid secretion.
• D. inhibits secretory surface of the parietal
  cells.

219

• C. inhibits gastric acid secretion.

220

• Mr. James is receiving Bumex because he exhibits
• A. alcohol abuse manifestations (DTs).
• B. bleeding tendencies and bruising.
• C. ascites and peripheral edema.
• D. mental confusion and weight gain.

221

• C. ascites and peripheral edema.

222

• Spironolactone (Aldactone) 25 mg is given to Mr.
  James bid. The nurse teaches Mr. James the
  rationale for this medication. Aldactone is an
• A. H2 blocker that controls HCl in the stomach.
• B. bronchodilator to decrease shortness of
  breath.
• C. anticoagulant to control bleeding esophageal
  varices.
• D. diuretic to execute excess sodium and water to
  decrease ascites and edema.

223

• D. diuretic to execute excess sodium and water to
  decrease ascites and edema.

224

• Mr. James is taking potassium (K-Dur) for
  electrolyte replacement due to use of diuretics.
  The nurse must be aware of the manifestations of
  hyperkalemia. These include
• A. muscle weakness, hypotension, and decreased
  cardiac contraction.
• B. hypoactive bowel sounds, ileus, and
  constipation.
• C. presence of Trousseaus and Chvosteks sign.
• D. polyuria, extreme lethargy, and confusion.

225

• A. muscle weakness, hypotension, and decreased
  cardiac contraction.

226

• Serum ammonia levels are drawn to detect hepatic
  encephalopathy. Mr. James ammonia is 79 mg/L, 30
  above normal. Select the manifestations that the
  nurse may find in Mr. James assessment related
  to elevated ammonia.
• A. Edema, pleural effusion, and ascites.
• B. Impaired memory, attention, and concentration.
  
• C. Mental alertness and asterixis.
• D. Ascites and bleeding esophageal varices.

227

• B. Impaired memory, attention, and concentration.
  

228

• Mr. James is scheduled for a paracentesis.
  Preparation for this procedure includes
• A. having the client urinate and assessing vital
  signs.
• B. drawing liver enzyme levels and total serum
  protein.
• C. obtaining a urine specimen and having client
  sign a permit.
• D. having the client sign a permit and calling
  radiology to schedule time for procedure.

229

• A. having the client urinate and assessing vital
  signs.

230

• Mr. James is to receive vitamin K (Mephyton) 5 mg
  twice weekly. The purpose of this drug is to
• A. assist the liver in controlling bleeding.
• B. increase the level of platelets in the body.
• C. stimulate the liver to produce prothrombin.
• D. stimulate the bone marrow to produce red blood
  cells.

231

• A. assist the liver in controlling bleeding.

232

• Splenomegaly is a major complication of
  cirrhosis. Select the manifestations of
  splenomegaly.
• A. RBC 2.78 million/mm3 and Hb 11.0 g/dl
• B. Abdominal girth of 52 inches and amber-colored
  urine
• C. Albumin 2.1 g/dl and total protein 5.0 g/dl
• D. Pitting pretibial and pedal edema

233

• A. RBC 2.78 million/mm3 and Hb 11.0 g/dl

234

• Mr. James asks why he developed ascites. The
  nurse explains that one of the reasons for
  ascites is the
• A. livers lack of production of vitamin K.
• B. spleens inability to filter the blood
  correctly.
• C. livers lack of ability to produce albumin.
• D. serum sodium level is too low.

235

• C. livers lack of ability to produce albumin.

236

• The physician orders salt-poor albumin for Mr.
  James. The nurse caring for Mr. James explains
  that albumin
• A. maintains colloidal osmotic pressure holding
  H2O in the blood vessels.
• B. excretes sodium through the kidneys decreasing
  edema and ascites.
• C. stimulates the liver to produce albumin to
  maintain a normal level.
• D. protects the esophageal varices from further
  bleeding.

237

• A. maintains colloidal osmotic pressure holding
  H2O in the blood vessels.

238

• Jaundice may result from
• A. conjugated hyperbilirubinemia.
• B. hepatocellular dysfunction.
• C. hepatitis.
• D. Both a and b

239

• D. Both a and b

240

• Unconjugated hyperbilirubinemia may result from
• A. overproduction of bilirubin.
• B. Dubin-Johnson syndrome.
• C. sepsis.

241

• A. overproduction of bilirubin.

242

• Which of the following is not a manifestation of
  jaundice?
• A. Tea-colored urine
• B. Pruritus
• C. Increased appetite
• D. Clay-colored feces

243

• C. Increased appetite

244

• What intervention is recommended for jaundiced
  clients who experience pruritus?
• A. Administer histamines.
• B. Administer antihistamines and phenobarbital.

245

• B. Administer antihistamines and phenobarbital.

246

• Which of the following is not a type of
  hepatitis?
• A. Toxic
• B. Alcoholic
• C. Bacterial
• D. Viral

247

• C. Bacterial

248

• Hepatitis A is also known as
• A. viral hepatitis.
• B. toxic hepatitis.
• C. bacterial hepatitis.
• D. infectious hepatitis.

249

• D. infectious hepatitis.

250

• What type of hepatitis transmission is caused by
  an RNA virus of the enterovirus family?
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D

251

• A. Hepatitis A

252

• The treatment of hepatitis C includes
  administering
• A. anti-HBs.
• B. immune globulin.
• C. interferon.
• D. HbsAg.

253

• C. interferon.

254

• What does the presence of HbsAg in the blood
  indicate?
• A. Previous infection with hepatitis
• B. Continuing chronic infection
• C. Immunization with immunoglobulin
• D. All of the above are correct.

255

• D. All of the above are correct.

256

• Which of the following is a clinical
  manifestation of viral hepatitis?
• A. Myalgia
• B. Increased appetite
• C. Muscle tissue necrosis
• D. Hypertension

257

• A. Myalgia

258

• Which of the following is not a medical
  management strategy for hepatitis?
• A. Reduce fatigue.
• B. Maintain nutritional and fluid balance.
• C. Administer glucocorticoid therapy.
• D. Administer antihistamines.

259

• B. Maintain nutritional and fluid balance.

260

• What medications should be avoided in the
  treatment of hepatitis?
• A. Aspirin
• B. Acetaminophen
• C. Antibiotics
• D. All of the above should be avoided.

261

• D. All of the above should be avoided.

262

• Clients with hepatitis often have
• A. normal appetites.
• B. increased appetites.
• C. decreased appetites.
• D. All of the above are correct.

263

• C. decreased appetites.

264

• Which of the following is necessary when treating
  an older client with complications of acute viral
  hepatitis?
• A. Avoid hepatotoxins.
• B. Promote rest.
• C. Prevent infection.
• D. All of the above are correct.

265

• D. All of the above are correct.

266

• Chronic hepatitis exists when liver inflammation
  continues beyond a period of
• A. 1 to 3 months.
• B. 3 to 6 months.
• C. 6 to 12 months.
• D. a year or more.

267

• B. 3 to 6 months.

268

• What are the three types of chronic hepatitis?
• A. Chronic hepatitis A, chronic hepatitis B, and
  autoimmune hepatitis
• B. Chronic hepatitis B, chronic hepatitis C, and
  autoimmune hepatitis
• C. Chronic hepatitis A, chronic hepatitis C, and
  autoimmune hepatitis
• D. Chronic hepatitis A, chronic hepatitis B, and
  chronic hepatitis C

269

• B. Chronic hepatitis B, chronic hepatitis C, and
  autoimmune hepatitis

270

• Palliative therapy for aplastic anemia includes
• A. reduction of fluids.
• B. no medications.
• C. correction of electrolyte abnormalities.
• D. increased food intake.

271

• C. correction of electrolyte abnormalities.

272

• What determines the extent and type of toxic
  hepatitis?
• A. The age of the client
• B. The chemical properties of the hepatotoxin
• C. The gender of the client
• D. None of the above is correct.

273

• B. The chemical properties of the hepatotoxin

274

• What are the major clinical problems in
  cirrhosis?
• A. Increased liver function and portal
  hypotension
• B. Increased liver function and portal
  hypertension
• C. Decreased liver function and portal
  hypotension
• D. Decreased liver function and portal
  hypertension

275

• D. Decreased liver function and portal
  hypertension

276

• What medications should be avoided in the
  treatment of cirrhosis?
• A. Codeine
• B. Acetaminophen
• C. Phenobarbital
• D. All of the above should be avoided.

277

• A. Codeine

278

• When performing sclerotherapy, an operator must
• A. pass an endoscope into the stomach and inject
  a sclerosing agent that flows into the varices.
• B. pass an endoscope into the esophagus and
  inject a sclerosing agent that flows into the
  varices.
• C. pass an endoscope into the small intestine and
  inject a sclerosing agent that flows into the
  varices.
• D. None of the above are correct.

279

• B. pass an endoscope into the esophagus and
  inject a sclerosing agent that flows into the
  varices.

280

• Why is the effectiveness of beta-adrenergic
  blocking agents limited in the management of
  acute variceal bleeding?
• A. Because they reduce the heart rate and mask
  the early manifestations of hypoglycemia
• B. Because they increase the heart rate and mask
  the early manifestations of hypoglycemia
• C. Because they reduce the heart rate and mask
  the early manifestations of hyperglycemia
• D. Because they increase the heart rate and mask
  the early manifestations of hyperglycemia

281

• A. Because they reduce the heart rate and mask
  the early manifestations of hypoglycemia

282

• What does ascitic fluid typically produce?
• A. Abdominal distention
• B. Bulging flanks
• C. Downward protruding umbilicus
• D. All of the above are correct.

283

• D. All of the above are correct.

284

• Which of the following is not an intervention of
  ascitic fluid?
• A. Monitor fluid intake and output.
• B. Administer albumin.
• C. Administer hepatotoxins.
• D. Avoid hepatotoxins.

285

• C. Administer hepatotoxins.

286

• What is the main contraindication to placement of
  a peritoneovenous shunt?
• A. The client's state of health is too poor to
  withstand the trauma of surgery
• B. The age of the client
• C. The client's attitude toward this surgery
• D. The client's medication

287

• A. The client's state of health is too poor to
  withstand the trauma of surgery

288

• What is the daily recommended protein consumption
  of a client with chronic hepatic encephalopathy?
• A. 30 to 40 g/day
• B. 40 to 50 g/day
• C. 50 to 60 g/day
• D. 60 to 70 g/day

289

• C. 50 to 60 g/day

290

• Metastatic malignant tumors of the liver
  generally arise from the
• A. gastrointestinal tract.
• B. breasts.
• C. lungs.
• D. All of the above are correct.

291

• D. All of the above are correct.

292

• Which of the following is not advised for
  diagnosis of hepatic tumors?
• A. Sonography
• B. Liver biopsy
• C. CT scanning
• D. Selective hepatic arteriography

293

• B. Liver biopsy

294

• How can metastatic cancers spread to the liver?
• A. By direct extension from adjacent organs
• B. Via the hepatic arterial system
• C. Via the portal venous system
• D. All of the above are correct.

295

• D. All of the above are correct.

296

• What would be a manifestation of metastatic
  malignancy of the liver?
• A. Manifestations of a specific secondary tumor
• B. Weight gain
• C. Manifestations of active liver disease
• D. Chest pain

297

• C. Manifestations of active liver disease

298

• What would be an acceptable route of access when
  performing a liver biopsy?
• A. Subcutaneous
• B. Indirect laparotomy
• C. Through a peritoneoscope
• D. Through an endoscope

299

• C. Through a peritoneoscope

300

• What would be a contraindication of liver
  transplantation?
• A. Life-threatening systemic diseases
• B. Active alcoholism
• C. HIV infection
• D. All of the above are correct.

301

• D. All of the above are correct.

302

• Which liver abscess condition may develop as a
  result of an obstruction of the bile ducts by
  stone or stricture?
• A. Amebiasis
• B. Portal vein bacteremia
• C. Bacterial cholangitis
• D. Hepatic arterial bacteremia

303

• C. Bacterial cholangitis

304

• The organ that plays a central role in many
  essential physiologic processes is the ____.

305

• liver

306

• ____ is formed from the breakdown of hemoglobin
  from RBCs by macrophages.

307

• Bilirubin

308

• Hepatocellular jaundice is due to ____ ____,
  ____, or ____ ____ ____ ____ ____ ____.

309

• defective uptake conjugation transport of
  bilirubin from the liver

310

• The most common blood-borne infection in the
  United States and many parts of the world is
  _____ _____.

311

• viral hepatitis

312

• The ____ ____ virus is a small defective RNA
  virus that causes hepatitis only in HB infection.

313

• hepatitis D

314

• ____ ____ has no effect on viral hepatitis and is
  of no value in its treatment.

315

• Glucocorticoid therapy

316

• Chronic persistent hepatitis is classified by
  grade as ____ chronic hepatitis and by stage as
  ____ fibrosis.

317

• minimal or mild absent or mild

318

• A disease of young women characterized by hepatic
  inflammation with plasma cells and fibrosis is
  called ____ ____ ____.

319

• autoimmune liver disease

320

• Standard therapy in the treatment of chronic
  hepatitis is a combination of recombinant ____
  ____ and ____.

321

• interferon (IFN) alfa ribavirin

322

• ____ of the liver is a chronic, progressive
  disease characterized by widespread fibrosis and
  nodule formation.

323

• Cirrhois

324

• The most feared complications of cirrhosis are
  ____, ____ ____ ____, and ____ ____.

325

• ascites bleeding esophageal varices hepatic
  encephalopathy

326

• ____ ____ exists when there is a persistent
  increase in blood pressure in the portal venous
  system.

327

• Portal hypertension

328

• The most common cause of portal hypertension is
  ____.

329

• cirrhosis

330

• Direct measurement of portal venous blood
  pressure is possible only during ____.

331

• laparotomy

332

• When pressure increases in the portal venous
  system, damage to the ____ occurs.

333

• spleen

334

• ____ ____ is an extremely dangerous complication
  of portal hypertension arising from a period of
  bleeding into the gastrointestinal tract.

335

• Hepatic encephalopathy

336

• A balloon tamponade intervention involves the
  insertion of a _____ or ____ ____ into the
  stomach that inflates the esophageal and gastric
  balloons.

337

• Sengstaken-Blakemore Minnesota tube

338

• In the ____ ____ ____ procedure, the esophageal
  varices are ligated and strangulated with small
  elastic O rings placed in the appropriate place
  during endoscopy.

339

• esophageal band ligation

340

• A _____ _____ is created by anastomosing the
  high-pressure portal venous system to the
  low-pressure venous system.

341

• portosystemic shunt

342

• The client with refractory and disabling chronic
  ascites may obtain relief from the insertion of a
  ____ ____.

343

• peritoneovenous shunt

344

• The cause of hepatic encephalopathy is the
  liver's inability to metabolize _____ to form
  urea.

345

• ammonia

346

• Normally the liver converts ammonia into ____.

347

• glutamine

348

• The presence of methylmercaptan causes a
  characteristic odor on the breath called _____
  _____.

349

• fetor hepaticus

350

• ____ ____ are benign tumors of the liver that
  occur most commonly in women in their 20s and 30s.

351

• Hepatic adenomas

352

• A liver ____ is a localized collection of pus and
  organisms within the parenchyma of the liver.

353

• abscess

354

• ___ is yellow pigmentation of the skin jaundice

355

• Icterus

356

• ___ is bile pigment product of red blood cell
  breakdown

357

• bilirubin

358

• Inflammation of the liver is known as ___

359

• hepatitis

360

• Abnormal muscle tremors liver flap is known as
  ___

361

• Asterixis

362

• Fluid accumulation in the peritoneum is known as
  ___

363

• ascites

364

• Increase in pressure in the portal vein resulting
  from obstruction of blood flow through the liver
  is known as ___ ___

365

• portal hypertension

366

• A ___ is a nasogastric tube used in the treatment
  of esophageal varices through inflation of
  balloons that provide tamponade on the bleeding
  varices

367

• Sengstaken-Blakemore

368

• Injection with a killed virus vaccine to produce
  immunity is known as ___ ___

369

• active immunization

370

• Immune globulin given after exposure to hepatitis
  is known as ___ ___

371

• passive immunity

372

• ___ ___ are enlarged esophageal veins resulting
  from portal hypertension

373

• Esophageal varices

374

• CNS disturbances caused by a buildup of ammonia
  in the blood is known as ___ ___

375

• hepatic encephalopathy

376

• Treatment for esophageal varices involving the
  injection of a sclerosing agent is known as ___

377

• sclerotherapy

378

• Congenital disorder of the liver characterized by
  portal fibrosis is known as ___ ___ ___

379

• Congenital hepatic fibrosis

380

• ___ ___ is a congenital disorder that leads to
  accumulation of copper in the liver, brain, and
  kidney

381

• Wilson's disease

382

• ___ ___ is a congenital disorder of the liver
  characterized by dilated bile ducts and cyst
  formation

383

• Caroli's syndrome

384

• ___ is a proteinaceous, starch-like substance
  that infiltrates the liver and other organs
  causing the tissue to cease functioning

385

• Amyloidosis

386

• ___ is a recessive, inherited metabolic defect
  that causes increased iron absorption from the
  gastrointestinal tract

387

• Hemochromatosis

388

• Choose the correct stage of hepatic
  encephalopathy that matches the following
  manifestation Coma.
• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

389

• D. Stage 4

390

• Choose the correct stage of hepatic
  encephalopathy that matches the following
  manifestation Severe confusion.
• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

391

• C. Stage 3

392

• Choose the correct stage of hepatic
  encephalopathy that matches the following
  manifestation Fatigue.
• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

393

• A. Stage 1

394

• Choose the correct stage of hepatic
  encephalopathy that matches the following
  manifestation Asterixis.
• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

395

• B. Stage 2

396

• Choose the correct stage of hepatic
  encephalopathy that matches the following
  manifestation Fetor hepaticus.
• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

397

• B. Stage 2

398

• Choose the correct stage of hepatic
  encephalopathy that matches the following
  manifestation Deep somnolence.
• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

399

• C. Stage 3

400

• Choose the correct stage of hepatic
  encephalopathy that matches the following
  manifestation Unresponsive to painful stimuli.
• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

401

• D. Stage 4

402

• Choose the correct stage of hepatic
  encephalopathy that matches the following
  manifestation Irritability.
• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

403

• A. Stage 1

404

• Choose the correct stage of hepatic
  encephalopathy that matches the following
  manifestation Personality changes.
• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

405

• A. Stage 1

406

• Choose the correct stage of hepatic
  encephalopathy that matches the following
  manifestation Decreased intellectual
  performance.
• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

407

• A. Stage 1

408

• Choose the the appropriate laboratory test that
  matches the following description Indicates
  previous exposure and immunity to hepatitis A.
  (More than one answer may apply.)
• A. HAV?Ab/IgG
• B. HAV?Ab/IgM
• C. HBeAg
• D. HBgAb
• E. HBsAb
• F. HBsAg

409

• A. HAV?Ab/IgG

410

• Choose the the appropriate laboratory test that
  matches the following description Indicates
  progression from active hepatitis to chronic
  hepatitis B. (More than one answer may apply.)
• A. HAV?Ab/IgG
• B. HAV?Ab/IgM
• C. HBeAg
• D. HBgAb
• E. HBsAb
• F. HBsAg

411

• D. HBgAb
• E. HBsAb
• F. HBsAg

412

• Choose the the appropriate laboratory test that
  matches the following description Indicates past
  infection with hepatitis B. (More than one answer
  may apply.)
• A. HAV?Ab/IgG
• B. HAV?Ab/IgM
• C. HBeAg
• D. HBgAb
• E. HBsAb
• F. HBsAg

413

• D. HBgAb
• E. HBsAb

414

• Choose the the appropriate laboratory test that
  matches the following description Indicates
  acute stage of hepatitis A. (More than one answer
  may apply.)
• A. HAV?Ab/IgG
• B. HAV?Ab/IgM
• C. HBeAg
• D. HBgAb
• E. HBsAb
• F. HBsAg

415

• B. HAV?Ab/IgM

416

• Choose the the appropriate laboratory test that
  matches the following description Indicates
  previous exposure to hepatitis B, a continuous
  chronic infection, or immunization with hepatitis
  B vaccine. (More than one answer may apply.)
• A. HAV?Ab/IgG
• B. HAV?Ab/IgM
• C. HBeAg
• D. HBgAb
• E. HBsAb
• F. HBsAg

417

• F. HBsAg

418

• Choose the the appropriate laboratory test that
  matches the following description Indicates
  resolution of acute stage of hepatitis B. (More
  than one answer may apply.)
• A. HAV?Ab/IgG
• B. HAV?Ab/IgM
• C. HBeAg
• D. HBgAb
• E. HBsAb
• F. HBsAg

419

• D. HBgAb
• E. HBsAb

420

• Choose the the appropriate laboratory test that
  matches the following description Indicates that
  the person is infectious. (More than one answer
  may apply.)
• A. HAV?Ab/IgG
• B. HAV?Ab/IgM
• C. HBeAg
• D. HBgAb
• E. HBsAb
• F. HBsAg

421

• F. HBsAg

422

• Choose the type of hepatitis that matches the
  following description Always found with
  hepatitis B. (More than one answer may apply.)
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D
• E. Hepatitis E
• F. Toxic hepatitis

423

• D. Hepatitis D

424

• Choose the type of hepatitis that matches the
  following description Also known as infectious
  hepatitis. (More than one answer may apply.)
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D
• E. Hepatitis E
• F. Toxic hepatitis

425

• A. Hepatitis A

426

• Choose the type of hepatitis that matches the
  following description Spread by carriers. (More
  than one answer may apply.)
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D
• E. Hepatitis E
• F. Toxic hepatitis

427

• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D

428

• Choose the type of hepatitis that matches the
  following description Spread by blood. (More
  than one answer may apply.)
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D
• E. Hepatitis E
• F. Toxic hepatitis

429

• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D

430

• Choose the type of hepatitis that matches the
  following description Primary prevention by
  careful hand-washing. (More than one answer may
  apply.)
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D
• E. Hepatitis E
• F. Toxic hepatitis

431

• A. Hepatitis A

432

• Choose the type of hepatitis that matches the
  following description Primary prevention by
  active immunity. (More than one answer may
  apply.)
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D
• E. Hepatitis E
• F. Toxic hepatitis

433

• B. Hepatitis B

434

• Choose the type of hepatitis that matches the
  following description Caused by benzene and
  chloroform. (More than one answer may apply.)
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D
• E. Hepatitis E
• F. Toxic hepatitis

435

• F. Toxic hepatitis

436

• Choose the type of hepatitis that matches the
  following description Health care workers at
  risk. (More than one answer may apply.)
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D
• E. Hepatitis E
• F. Toxic hepatitis

437

• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D

438

• Choose the type of hepatitis that matches the
  following description Spread by contaminated
  shellfish, water, and milk. (More than one answer
  may apply.)
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D
• E. Hepatitis E
• F. Toxic hepatitis

439

• A. Hepatitis A

440

• Choose the type of hepatitis that matches the
  following description Contracted through travel
  in high-incidence areas. (More than one answer
  may apply.)
• A. Hepatitis A
• B. Hepatitis B
• C. Hepatitis C
• D. Hepatitis D
• E. Hepatitis E
• F. Toxi