Competency 6 - Liver
The nurse is caring for a client with chronic liver failure. Which laboratory value would be most concerning?
A. Albumin 2.1 g/dL
B. Sodium 138 mEq/L
C. Potassium 4.2 mEq/L
D. Glucose 110 mg/dL
A. Albumin 2.1 g/dL
A client with Graves disease presents with:
A. Weight gain, bradycardia, and cold intolerance
B. Weight loss, tachycardia, and heat intolerance
C. Polyuria and polydipsia
D. Jaundice and ascites
B. Weight loss, tachycardia, and heat intolerance
When assessing a client with kidney disease, which finding best reflects fluid volume excess?
A. Dry mucous membranes
B. Increased skin turgor
C. Jugular venous distention
D. Weight loss
C. Jugular venous distention
The nurse is assessing a client with suspected rheumatoid arthritis (RA). Which assessment finding is most suggestive of RA rather than osteoarthritis?
A. Crepitus in the knees after activity
B. Heberden's nodes
C. Symmetrical swelling of small joints of the hands
D. Pain improved by rest
C. Symmetrical swelling of small joints of the hands
A psychiatric client tells the nurse, “When I leave here tomorrow, I am going to kill my ex-partner.” What is the nurse's priority action?
A. Maintain complete confidentiality.
B. Notify appropriate providers according to duty-to-warn laws and facility policy.
C. Ignore the statement because it may be manipulative.
D. Discuss the situation only with coworkers.
B. Notify appropriate providers according to duty-to-warn laws and facility policy.
A 3-year-old is admitted for surgery. Which communication strategy is most appropriate?
A. Provide detailed anatomical explanations.
B. Explain procedures immediately before they occur using simple language.
C. Direct all communication to the parents.
D. Use abstract concepts.
B. Explain procedures immediately before they occur using simple language.
Which statement best describes a primary function of the liver?
A. Production of insulin
B. Filtration of cerebrospinal fluid
C. Metabolism of nutrients, medications, and toxins
D. Production of red blood cells throughout life
C. Metabolism of nutrients, medications, and toxins
A client newly diagnosed with Type 1 diabetes mellitus asks why insulin is necessary. Which response by the nurse is most accurate?
A. The pancreas produces insulin, but body cells cannot use it effectively.
B. Autoimmune destruction of beta cells has resulted no insulin production.
C. Excess glucagon production prevents insulin release.
D. The liver is unable to store glycogen.
B. Autoimmune destruction of beta cells has resulted no insulin production.
A client with CKD reports shortness of breath. Which assessment finding most strongly suggests pulmonary edema?
A. Crackles bilaterally
B. Warm skin
C. Weight loss
D. Flat neck veins
A. Crackles bilaterally
A client with SLE reports increasing edema and weight gain. Which laboratory finding would the nurse anticipate?
A. Albumin 2.2 g/dL
B. Uric acid 4.0 mg/dL
C. WBC 8,000/mm³
D. Calcium 9.2 mg/dL
A. Albumin 2.2 g/dL
A client voluntarily admitted to an inpatient psychiatric unit requests discharge. Which statement by the nurse is most accurate?
A. "Voluntary clients can never request discharge."
B. "Your request must be evaluated according to state law and facility policy."
C. "You immediately lose all rights after admission."
D. "Only family members may request discharge."
B. "Your request must be evaluated according to state law and facility policy."
A nurse is assessing a 15-month-old hospitalized child. The child cries when separated from the parent and refuses interaction with staff. According to Erikson, which developmental task is most relevant?
A. Initiative vs. Guilt
B. Industry vs. Inferiority
C. Trust vs. Mistrust
D. Autonomy vs. Shame and Doubt
D. Autonomy vs. Shame and Doubt
The nurse is evaluating the effectiveness of lactulose therapy. Which finding indicates the medication is working as intended?
A. Decreased ammonia level
B. Increased blood pressure
C. Increased appetite only
D. Decreased respiratory rate
A. Decreased ammonia level
A client receiving rapid-acting insulin becomes diaphoretic, anxious, and confused. Blood glucose is 48 mg/dL. Which action should the nurse take first?
A. Administer a complex carbohydrate.
B. Administer IV glucose
C. Encourage fluid hydration
D. Administer a simple carbohydrate
D. Administer a simple carbohydrate
A client on peritoneal dialysis has an inflow of 2000 mL and an outflow of 2400 mL. How should the nurse interpret this finding?
A. Dialysis is ineffective.
B. Fluid removal has occurred.
C. A leak is present.
D. The documentation is incorrect.
B. Fluid removal has occurred.
Which assessment finding requires immediate follow-up in a client with lupus?
A. Fatigue
B. Photosensitivity
C. BP 168/98 with proteinuria
D. Joint discomfort
C. BP 168/98 with proteinuria
Which client statement indicates the highest suicide risk?
A. "Sometimes life feels difficult."
B. "I wish I could sleep forever."
C. "I have a gun at home and plan to use it tonight."
D. "I feel lonely."
C. "I have a gun at home and plan to use it tonight."
A 4-year-old believes a hospital procedure is punishment for bad behavior. According to Piaget, this thinking is most consistent with:
A. Formal operations
B. Concrete operations
C. Sensorimotor thought
D. Preoperational thought
D. Preoperational thought
A client with cirrhosis is admitted with increasing confusion. Which assessment finding most strongly suggests hepatic encephalopathy?
A. Elevated serum potassium level
B. Asterixis and altered mental status
C. Bradycardia and hypertension
D. Increased appetite and weight gain
B. Asterixis and altered mental status
A client with DKA has:
Which intervention should the nurse anticipate first?
A. IV fluids B. Insulin therapy C. Potassium supplements immediately D. Fluid restriction
A. IV fluids
A client with CKD reports increasing fatigue. Which pathophysiologic mechanism most likely explains this symptom?
A. Excess erythropoietin production
B. Decreased erythropoietin production
C. Hypercalcemia
D. Increased oxygen transport
B. Decreased erythropoietin production
A client with severe osteoarthritis asks why pain worsens after prolonged activity. Which explanation is most accurate?
A. Autoimmune destruction of synovium increases throughout the day.
B. Degeneration of articular cartilage increases friction during movement.
C. Uric acid crystals accumulate during exercise.
D. Immune complexes attack joint surfaces.
B. Degeneration of articular cartilage increases friction during movement.
A client taking sertraline for depression asks when symptom improvement should occur. Which response is most accurate?
A. "Usually within a few hours."
B. "Most antidepressants require several weeks for full therapeutic effects."
C. "Only one dose is necessary."
D. "The medication works immediately and permanently."
A client taking sertraline for depression asks when symptom improvement should occur. Which response is most accurate?
Which approach is most effective when assessing pain in a 2-year-old child?
A. Numeric rating scale
B. Visual analog scale
C. Behavioral pain assessment scale
D. Written questionnaire
C. Behavioral pain assessment scale
A nurse observes a client with cirrhosis scratching continuously. Which explanation is most accurate?
A. Elevated bilirubin causes pruritus.
B. Hyperglycemia causes itching.
C. Dehydration causes itching.
D. Hypertension causes itching.
A. Elevated bilirubin causes pruritus.
The nurse identifies the anterior pituitary as responsible for secretion of which hormone?
A. TSH
B. Aldosterone
C. Epinephrine
D. Calcitonin
A. TSH
A client with Stage 5 CKD asks why phosphate binders are prescribed. Which response is most accurate?
A. "They lower potassium levels."
B. "They prevent absorption of phosphorus from food."
C. "They increase urine production."
D. "They treat anemia."
B. "They prevent absorption of phosphorus from food."
A client with rheumatoid arthritis asks why methotrexate is prescribed. Which explanation is most accurate?
A. It cures RA permanently.
B. It suppresses inflammatory and immune responses to slow disease progression.
C. It replaces damaged cartilage.
D. It lowers uric acid levels.
B. It suppresses inflammatory and immune responses to slow disease progression.
A client experiencing severe anxiety is hyperventilating and unable to concentrate. What is the nurse's priority intervention?
A. Discuss possible triggers
B. Assist the client to focus on slow breathing
C. Discuss long-term career goals
D. Leave the client alone
B. Assist the client to focus on slow breathing
A 2-year-old child weighs 12 kg. The prescribed dose is 15 mg/kg/day divided into 3 equal doses. How much medication should the child receive per dose?
60 mg