hep-biliary
A client's long-standing diagnosis of congenital hemolytic anemia often manifests itself with jaundice. What type of jaundice does this client most likely experience?
A) Prehepatic
B) Intrahepatic
C) Posthepatic
D) Infectious
Ans: A
The major cause of prehepatic jaundice is excessive hemolysis of red blood cells. Hemolytic jaundice occurs when red blood cells are destroyed at a rate in excess of the liver's ability to remove the bilirubin from the blood. Intrahepatic jaundice involves dysfunction of the liver itself, whereas posthepatic causes usually involve obstruction. The classification of jaundice does not include an infectious type.
Which of the following factors is most strongly associated with the pathogenesis of gallstones?
A) Excess serum ammonia and urea levels
B) Portal hypertension
C) Abnormalities or stasis of bile
D) High-cholesterol diet
Three factors contribute to the formation of gallstones: abnormalities in the composition of bile, stasis of bile, and inflammation of the gallbladder. Portal hypertension, a high-cholesterol diet, and excess ammonia and/or urea are not causative factors of cholelithiasis.
The most common cause of thyrotoxicosis is Graves disease. When assessing this client, the nurse should put priority on which of the following signs/symptoms?
A) Complaints of muscle fatigue
B) Facial myxedema with puffy eyelids
C) Exophthalmos
D) Pulse rate of 64 beats/minute
C
Antibody testing has confirmed that a man is positive for hepatitis A virus (HAV). Which of the client's statements suggests that he understands his new diagnosis:
A) “I guess I'm an example of why you should always use condoms.”
B) “I'm embarrassed that I'll be a carrier of hepatitis from now on.”
C) “I'm still trying to deal with the fact that this will forever change my life.”
D) “I don't know why I didn't bother to get vaccinated against this.”
Ans: D
A vaccine is available for HAV. The disease is normally self-limiting and does not result in carrier status. Transmission is usually by the fecal–oral route, rather than sexual transmission.
Which of the following signs and symptoms is most suggestive of acute cholecystitis?
A) Upper right quadrant or epigastric pain
B) Fever and sudden abdominal distention
C) Appearance of undigested fat in feces
D) Nausea resulting in greenish vomitus
Ans: A
Persons with acute cholecystitis usually experience an acute onset of upper right quadrant or epigastric pain. Nausea and vomiting are also common, although these are not specific to cholecystitis. Abdominal distention and steatorrhea are not key signs of acute cholecystitis.
The iatrogenic form of Cushing syndrome is caused by:
A) Long-term cortisone therapy
B) Pituitary tumor secreting ACTH
C) Benign or malignant adrenal tumor
D) Ectopic ACTH-secreting lung tumor
Ans:A
Three important forms of Cushing syndrome result from excess glucocorticoid production by the body. One is a pituitary form, which results from excessive production of ACTH by a tumor of the pituitary gland, called Cushing disease. The second form is the adrenal form, caused by a benign or malignant adrenal tumor. The third form is ectopic Cushing syndrome, caused by a nonpituitary ACTH-secreting tumor, often carcinoma of the lung. Iatrogenic Cushing syndrome results from long-term therapy with one of the potent pharmacologic preparations of glucocorticoids.
A hospital client with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following effects will result from the action of insulin?
A) Promotion of fat breakdown
B) Promotion of glucose uptake by target cells
C) Promotion of gluconeogenesis
D) Initiation of glycogenolysis
Ans: B
The actions of insulin are threefold: (1) it promotes glucose uptake by target cells and provides for glucose storage as glycogen; (2) it prevents fat and glycogen breakdown; and (3) it inhibits gluconeogenesis and increases protein synthesis. Glucagon, not insulin, promotes glycogenolysis.
Clients with chronic autoimmune hepatitis may display which of the following clinical manifestations upon physical exam? Select all that apply.
A) Enlarged liver
B) Jaundice
C) Bacterial meningitis
D) Nuchal rigidity
E) Edematous joints
Ans: A, B
Clinical manifestations of the disorder cover a spectrum that extends from no apparent symptoms to the signs of liver failure. Physical exam may reveal no abnormalities but may also reveal hepatomegaly, splenomegaly, jaundice, and signs of chronic liver disease. Bacterial meningitis and nuchal rigidity are not manifestations of this disorder.
When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize the pathogenesis begins with an inflammatory process whereby:
A) Activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue.
B) The pancreas is irreversibly damaged and will not recover to normal functioning (chronic).
C) The pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction.
D) Stones will develop in the common bile duct, resulting in acute jaundice.
Ans: A
Acute pancreatitis is associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues. These enzymes cause fat necrosis, or autodigestion, of the pancreas. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct, rather than bowel obstruction. The pancreas is irreversibly damaged and will not recover to normal functioning results from chronic pancreatitis. Acute pancreatitis also is associated with viral infections. The pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction occurring with cancer of the pancreas. Presence of stones in the common bile duct with jaundice is primarily a result of gallstones.
A client with type 1 diabetes has started a new exercise routine. Knowing there may be some increase risks associated with exercise, the health care provider should encourage the client to:
A) Watch for too rapid weight loss
B) Monitor for respiratory disorders
C) Be careful that you're not experiencing a rebound hyperglycemia
D) Carry a snack with carbs to prevent profound hypoglycemia
Ans:D
People with diabetes are usually aware that delayed hypoglycemia can occur after exercise. Although muscle uptake of glucose increases significantly, the ability to maintain blood glucose levels is hampered by failure to suppress the absorption of injected insulin and activate the counterregulatory mechanisms that maintain blood glucose (to cause a hyperglycemia response). Even after exercise ceases, insulin's lowering effect on blood glucose levels continues, resulting in profound symptomatic hypoglycemia. Rapid weight loss accompanies the polyuria and dehydration of hyperglycemia rather than hypoglycemia. Respiratory disorders are associated with preexisting pulmonary or vascular problems exacerbated by the period of exercise.
A client is suspected of having the onset of alcoholic liver disease. The nurse should be assessing for which of the following manifestations related to the necrosis of liver cells?
A) Tremors of the hands
B) Rapid onset of jaundice
C) Long muscle group atrophy
D) Development of multiple skin nodules
Ans: B
Alcoholic hepatitis is the intermediate stage between fatty changes and cirrhosis and is characterized by inflammation and necrosis of liver cells. The condition is always serious and sometimes fatal. The cardinal sign of alcoholic hepatitis is rapid onset of jaundice. Hand tremors are not specific to alcoholic hepatitis. Long muscle group atrophy can occur but is not the primary sign. Development of nodules is not caused by alcoholic hepatitis.
Which of the following individuals displays the precursors to acromegaly?
A) An adult with an excess of growth hormone due to an adenoma
B) A girl who has been diagnosed with precocious puberty
C) An adult who has a diagnosis of Cushing syndrome
D) A client who has recently developed primary adrenal carcinoma
Ans: A
When growth hormone (GH) excess occurs in adulthood or after the epiphyses of the long bones have fused, it causes a condition called acromegaly, which represents an exaggerated growth of the ends of the extremities.
A client tells his health care provider that his body is changing. It used to be normal for his blood glucose to be higher during the latter part of the morning. However, now his fasting blood glucose level is elevated in the early AM (07:00). The health care provider recognizes the client may be experiencing:
A)Possible stress-related hypoglycemia
B)Somogyi effect
C)Hyperglycemic hyperosmolar state (HHS)
D)Dawn phenomenon
Ans: D
A change in the normal circadian rhythm for glucose tolerance, which usually is higher during the later part of the morning, is altered in people with diabetes, with abnormal nighttime growth hormone secretion as a possible factor. The dawn phenomenon is characterized by increased levels of fasting blood glucose or insulin requirements, or both, between 5 AM and 9 AM without preceding hypoglycemia. The Somogyi effect describes a cycle of insulin-induced posthypoglycemic episodes. The cycle begins when the increase in blood glucose and insulin resistance is treated with larger insulin doses. The insulin-induced hypoglycemia produces a compensatory increase in blood levels of catecholamines, glucagon, cortisol, and growth hormone, leading to increased blood glucose with some insulin resistance.
A major factor in the development of hepatic encephalopathy is:
A) Hypersplenism
B) High sodium level
C) Neurotoxin accumulation
D) Steroid hormone deficiency
Ans: C
Although the cause of hepatic encephalopathy is unknown, the accumulation of neurotoxins, which appear in the blood because the liver has lost its detoxifying capacity, is believed to be a factor. The liver metabolizes the steroid hormones; therefore, these hormones are often elevated in persons with liver failure and cause feminization (rather than encephalopathy) of male clients. Hypersplenism associated with liver failure is a factor in the development of anemia, thrombocytopenia, and leukopenia. Although the mechanisms responsible for the development of ascites are not completely understood, several factors seem to contribute to fluid accumulation, including salt and water retention by the kidney and increase in capillary pressure due to portal hypertension and obstruction of venous flow through the liver.
Which of the following residents of a long-term facility is exhibiting clinical manifestations of hypothyroidism?
A) An 80-year-old woman who has uncharacteristically lost her appetite and often complains of feeling cold
B) A 90-year-old woman with a history of atrial fibrillation whose arrhythmia has recently become more severe
C) An 88-year-old man with a history of Alzheimer disease who has become increasingly agitated and is wandering around the facility more frequently
D) A 91-year-old man with a chronic venous ulcer and a sacral ulcer who has developed sepsis
Ans: A
Loss of appetite and cold intolerance are characteristic symptoms of hypothyroidism. Arrhythmias, agitation, and infections are not typically associated with hypofunction of the thyroid gland.