NCLEX-PN Test #19 2 — Questions and Answers
Question 1: A client with esophageal varices is at risk for massive hemorrhage. Which medication is used to reduce portal pressure and variceal bleeding?
- Pantoprazole (Protonix)
- Octreotide (Sandostatin) (Correct answer)
- Lactulose
- Spironolactone (Aldactone)
Correct answer: Octreotide (Sandostatin)
Octreotide is a somatostatin analogue that reduces splanchnic blood flow and portal pressure, decreasing variceal bleeding. It is given IV in acute variceal hemorrhage as an adjunct to endoscopy. Pantoprazole treats peptic ulcers; lactulose reduces ammonia in hepatic encephalopathy; spironolactone treats ascites.
Question 2: A client with jaundice, right upper quadrant pain, and clay-colored stools is diagnosed with obstructive jaundice. Which laboratory finding is most consistent?
- Elevated indirect (unconjugated) bilirubin with normal ALP
- Elevated direct (conjugated) bilirubin with elevated alkaline phosphatase (ALP) (Correct answer)
- Elevated AST and ALT with normal bilirubin
- Low albumin with prolonged PT only
Correct answer: Elevated direct (conjugated) bilirubin with elevated alkaline phosphatase (ALP)
Obstructive jaundice (bile duct blockage by gallstone or tumor) causes conjugated (direct) bilirubin to accumulate in the blood (it is water-soluble and appears in the urine — dark urine) and prevents bile from entering the intestine (clay-colored stools). Elevated direct bilirubin with elevated ALP (cholestatic pattern) is characteristic.
Question 3: The PN is caring for a client after cholecystectomy (laparoscopic). Which teaching point is most important for the first 24 hours at home?
- A high-fat diet will help the liver recover by stimulating bile production
- Report severe shoulder or abdominal pain, fever, jaundice, or wound drainage that is yellow-green (Correct answer)
- The patient can resume all pre-surgery activities including heavy lifting immediately
- Diarrhea for up to 6 weeks post-surgery is considered abnormal and requires immediate evaluation
Correct answer: Report severe shoulder or abdominal pain, fever, jaundice, or wound drainage that is yellow-green
After laparoscopic cholecystectomy, warning signs requiring immediate medical evaluation include: severe abdominal or shoulder pain (may indicate bile leak or retained stone), fever > 38°C (infection), jaundice (bile duct injury or retained stone), and purulent wound drainage. Mild diarrhea for a few weeks as the body adjusts to continuous bile flow is expected.
Question 4: A client with ulcerative colitis has bloody diarrhea 8–10 times per day. The nurse assesses the client and notes HR 118 bpm, BP 90/60, pale, and confused. What is the priority action?
- Administer a scheduled rectal corticosteroid enema as ordered
- Initiate IV access, notify the provider, prepare for fluid resuscitation and blood products (Correct answer)
- Increase the client's oral fluid intake
- Position in high-Fowler's and administer supplemental oxygen only
Correct answer: Initiate IV access, notify the provider, prepare for fluid resuscitation and blood products
This presentation (tachycardia, hypotension, pallor, confusion with bloody diarrhea) indicates hemorrhagic shock from severe ulcerative colitis flare — a medical emergency. Priorities: IV access × 2, blood type and crossmatch, aggressive fluid resuscitation, notify provider, and prepare for possible emergency colectomy. Airway and IV access are immediate priorities.
Question 5: The nurse is preparing a client for a liver biopsy. Which position should the client be placed in immediately after the procedure?
- Left lateral decubitus (left side-lying) position
- Right lateral decubitus (right side-lying) position with rolled towel under puncture site (Correct answer)
- Trendelenburg position
- Supine with legs elevated 30 degrees
Correct answer: Right lateral decubitus (right side-lying) position with rolled towel under puncture site
After liver biopsy, the client is positioned on the right side with a small roll or pillow under the puncture site. This uses the body weight to apply pressure to the biopsy site, compressing it against the ribs to prevent hemorrhage. The liver is on the right; right-side lying provides direct pressure to the site.
Question 6: A client with hepatitis B asks the nurse how the virus is most commonly transmitted. What is the correct response?
- "Hepatitis B is transmitted through contaminated food and water."
- "Hepatitis B is spread through respiratory droplets in crowded settings."
- "Hepatitis B is transmitted through blood, sexual contact, and from mother to newborn at birth." (Correct answer)
- "Hepatitis B is only transmitted through shared needles — you are safe otherwise."
Correct answer: "Hepatitis B is transmitted through blood, sexual contact, and from mother to newborn at birth."
Hepatitis B (HBV) is a bloodborne pathogen transmitted through: blood and blood products (transfusions, needlestick, IV drug use with shared needles), unprotected sexual contact (it is 100× more infectious than HIV via this route), and vertical transmission from HBV-positive mother to newborn. Hepatitis A is fecal-oral (food/water-borne).
NCLEX-PN Test #19 2
A client with esophageal varices is at risk for massive hemorrhage.
Which medication is used to reduce portal pressure and variceal bleeding?