Deck 45: Care of the Patient with a Gallbladder, Liver, Biliary Tract, or Exocrine Pancreatic Disorder

Question 1

Which patient statement indicates that the patient requires additional teaching about an endoscopic retrograde cholangiopancreatography?

A) "Right after the test, I want breakfast with black coffee."
B) "The instrument will be put down my throat."
C) "I haven't had anything to eat or drink since 9 PM last night."
D) "My doctor said I could have medicine to relax me before the test."

Answer 1

"Right after the test, I want breakfast with black coffee."

Question 2

A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. What is the purpose of the T-tube?

A) To decompress the duct and relieve pain caused by stimulation of the sphincter of Oddi.
B) To improve diaphragmatic expansion and prevention of atelectasis.
C) To shorten postoperative recovery and hasten the healing process.
D) To keep the duct open and allow drainage of the bile until edema resolves.

Answer 2

To keep the duct open and allow drainage of the bile until edema resolves.

Question 3

What is the most common procedure for the removal of the gallbladder?

A) Laparoscopic cholecystectomy
B) Cholangiography
C) Open cholecystectomy
D) Choledochostomy

Answer 3

Laparoscopic cholecystectomy

Question 4

What should the nurse do to prepare a patient for an oral cholecystography?

A) Ensure that the patient drinks 500 mL of water before testing
B) Give 4 Oragrafin (ipodate) 5 minutes apart starting at 6 AM
C) Administer 6 Telepaque (iopanoic acid) tablets 5 minutes apart after the evening meal
D) Give a fatty meal $\frac { 1 } { 2 }$ hour before the test is started

Question 5

How does the administration of neomycin (Mycifradin) reduce the production of ammonia?

A) By assisting the hepatic cells to regenerate
B) By reducing ascites
C) By decreasing the bacteria in the gut
D) By helping to digest fats and proteins

Question 6

Which nursing intervention should be completed immediately after the physician has performed a needle liver biopsy?

A) Assisting to ambulate for the bathroom
B) Keeping the patient on the right side for a minimum of 2 hours
C) Taking vital signs every 4 hours
D) Keeping the patient on the left side for a minimum of 4 hours

Question 7

What is the most appropriate method used by high-risk health workers to prevent hepatitis B?

A) Hepatitis B vaccine
B) Diligent handwashing
C) Wearing protective gear
D) Hb immune globulin injections

Question 8

What should the nurse point out as a significant advantage of the laparoscopic cholecystectomy?

A) Slightly more invasive, but there is less pain
B) Can be performed on all patients of any age
C) Can be performed even when there are large stones present in the bile duct
D) Less invasive procedure

Question 9

Which of the following is a classic symptom of cholecystitis?

A) Substernal, radiating to the left shoulder and arm
B) Epigastric, radiating to the back
C) Right upper abdomen, radiating to the back or right scapula
D) Left upper abdomen, radiating to the jaw and neck

Question 10

The nurse assisting in the treatment of a patient with ruptured esophageal varices who has received vasopressin IV will carefully assess for:

A) Muscular twitching/spasm
B) Hematuria
C) Macular rash on trunk and arms
D) Evidence of cardiac ischemia

Question 11

The nurse caring for a patient who has had an open cholecystectomy with a T-Tube will:

A) open the T-tube to the air so that it will drain freely.
B) position and secure the drainage bag at the chest level.
C) Place the collection bag so the tube is not kinked.
D) Irrigate the T-tube with normal saline to ensure the free flow of bile.

Question 12

The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient waves to the nurse as she enters the room. How should the nurse interpret this?

A) As an attempt to get the nurse's attention
B) As asterixis
C) As an indication of respiratory obstruction from varices
D) As spasticity

Question 13

What should the nurse avoid contamination from to prevent the transmission of hepatitis A?

A) Food or water
B) Blood transfusion
C) Needles
D) Sexual contact

Question 14

The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5 g/dL to 5 g/dL. Based on these findings, what would the nurse expect the patient to exhibit?

A) Jaundice
B) Edema
C) Copious urine output
D) Pallor

Question 15

What should the nurse explain is the major purpose of the Sengstaken-Blakemore tube (S/B tube)?

A) Decompress the stomach
B) Control esophageal varices bleeding
C) A route for tube feedings
D) Obtain specimen for gastric analysis

Question 16

The nurse clarifies that unconjugated bilirubin, which is made up of broken-down red cells, is:

A) stored in the gallbladder to make bile.
B) water insoluble bilirubin that must be converted by the liver.
C) a by-product which is excreted directly into the bowel for excretion.
D) necessary for digestion of fats.

Question 17

The patient's cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of the complication of:

A) esophageal varices.
B) diverticulosis.
C) Crohn disease.
D) esophageal reflux (GERD).

Question 18

What is an essential nursing measure to prevent injury to the patient who is to receive a paracentesis?

A) Have patient sign a permit
B) Pad side rails
C) Check for allergy to contrast media or to shellfish
D) Have patient void immediately before procedure

Question 19

Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. What should the nurse suspect?

A) Peritonitis
B) Pneumothorax
C) Hemorrhage of the liver
D) Pleural effusion

Question 20

What should the nurse expect of a patient with a malabsorption of vitamin K?

A) Lowered hemoglobin
B) Elevated hematocrit
C) Increased prothrombin time
D) Diminished white blood cell count

Question 21

What should the nurse monitor in caring for the patient undergoing a paracentesis?

A) The urinary output
B) Hypervolemia
C) Fluid removal over at least 30 minutes
D) Seizure

Question 22

Why is it advantageous for a live person to be a liver donor?

A) Because the donor is not at risk for any complication
B) Because the recipient is more likely to avoid rejection
C) Because the donor donates only a part of the liver
D) Because the blood supply is more dependable in the donated liver

Question 23

Dietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which foods should be avoided? (Select all that apply.)

A) Peanut butter
B) Grilled chicken
C) Rice and pasta
D) Bananas, apples, oranges
E) Whole milk
F) Glazed chocolate doughnuts

Question 24

What are the indications for a liver transplant? (Select all that apply.)

A) Congenital biliary abnormalities
B) Hepatic malignancy
C) Chronic hepatitis
D) Cirrhosis due to alcoholism
E) Gallbladder disease

Question 25

When caring for an extremely jaundiced patient with cirrhosis, what should the nurse include provisions for in the plan of care?

A) Encouraging consumption of a high-fat diet
B) Skin care to relieve pruritus
C) Offering foods rich in fat-soluble vitamins
D) Meticulous foot care

Question 26

The nurse is aware that an elevated serum amylase is diagnostic of pancreatitis at an early stage as an elevation can be assessed as early as _____ after the onset of pancreatic disease.

A) 2 hours
B) 8 hours
C) 24 hours
D) 36 hours

Question 27

A male patient states that he returned from a 2-week camping trip a few days ago. He complains of nausea and anorexia, and dark urine. What additional information would assist in diagnosing hepatitis A?

A) Exposure to blood
B) Recent ingestion of raw fish
C) History of intravenous drug use
D) Multiple sex partners

Question 28

What is the challenge in encouraging coughing and deep breathing for a postoperative patient who had an open cholecystectomy?

A) High placement of incision
B) Excessive nausea
C) Weakened abdominal muscles
D) Poor oxygenation

Question 29

The nurse is aware that the hepatitis A immunization provides immunity in:

A) 5 days.
B) 10 days.
C) 15 days.
D) 30 days.

Question 30

Which factors may increase a patient's risk of developing cancer of the pancreas?

A) Diet high in carbohydrates and dairy products
B) Cardiovascular disease and glaucoma
C) Tea and cola consumption
D) Cigarette smokers and people with diabetes mellitus

Question 31

Which factors are most commonly associated with pancreatitis?

A) Coronary artery disease
B) Alcoholism and biliary tract disease
C) Cirrhosis
D) History of myocardial infarction

Question 32

Which medical interventions and management systems control the bleeding of esophageal varices? (Select all that apply.)

A) Transfusions
B) Sengstaken-Blakemore tube
C) Band ligation
D) Cryotherapy
E) Portocaval shunt
F) Large doses of vitamin B12

Question 33

The nurse would make provisions in the plan of care for a person who has had a liver transplant to prevent:

A) fluid congestion.
B) fatigue.
C) infection.
D) urinary retention.

Question 34

The nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug:

A) increases the rate of the regeneration of liver cells.
B) can overcome complications presented by hepatitis C.
C) increases blood supply to transplant.
D) does not suppress bone marrow.

Question 35

Which assessment would indicate possible gallbladder disease in an older adult?

A) Dull pain in the right upper quadrant region
B) Changes in color of urine or stool
C) Distention of veins in upper part of body
D) Aching muscles and tenderness in the liver

Question 36

A patient with a T-tube for an open cholecystectomy has resumed oral intake. The T-tube is clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of fat. During the time the tube is clamped the patient complains of abdominal pain and nausea. Which intervention is most appropriate?

A) Notify the physician
B) Unclamp the tube immediately
C) Increase the IV fluids
D) Change the T-tube dressing

Question 37

A family member of a patient asks the nurse about the protein-restricted diet ordered because of advanced liver disease with hepatic encephalopathy. What statement by the nurse would best explain the purpose of the diet?

A) "The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system."
B) "The liver heals better with a high-carbohydrate diet rather than with a diet high in protein."
C) "Most people have too much protein in their diets. The amount in this diet is better for liver healing."
D) "Because of portal hypertension, the blood flows around the liver, and ammonia made from protein collects in the brain, causing hallucinations."

Question 38

The 100 lb patient who has been exposed to hepatitis A is to receive an injection of immune serum globulin. What should the dose (.02 mL/kg) be?

A) 0.9 mL
B) 1.4 mL
C) 1.6 mL
D) 1.8 mL

Question 39

Why is morphine contraindicated in the patient with pancreatitis?

A) Demerol (meperidine) is less expensive.
B) Tylenol is more effective at managing this type of pain.
C) Morphine may cause spasms of the sphincter of Oddi.
D) These patients do not experience pain.

Question 40

A patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. Which of the following is the best response?

A) "Diagnostic tests depend on you not eating anything."
B) "The pancreas is stimulated whenever you eat or drink, and causes pain."
C) "Eating causes the need for a bowel movement, which excretes your medication too rapidly."
D) "Resting your GI tract will cure your pancreatitis."

Question 41

Viral hepatitis may be treated at home. What should be taught to the patient's family? (Select all that apply.)

A) Clothes should be laundered separately with hot water.
B) Personal items and drinking glasses should not be shared.
C) Articles soiled with feces do not require extra care.
D) Hands need to be thoroughly washed after toileting.
E) Contaminated items may be disposed of with regular trash.

Question 42

___________ is a condition characterized by yellowing of the sclera and the skin.

Question 43

The tumor marker that is elevated in patients with pancreatic cancer is______.

Question 44

A ___________occurs when the body encapsulates the autodigestive debris in the pancreatic tissue, frequently becoming an abscess.

Question 45

Hepatitis D is usually seen as a co-infection with __________.

Question 46

The nurse is aware that the liver synthesizes products essential to health. Which products are synthesized by the liver? (Select all that apply.)

A) Intrinsic factor
B) Protein
C) Vitamin K
D) Red blood cells
E) Albumin

Question 47

What should the nurse do as part of the preparation for an endoscopic retrograde cholangiopancreatography (ERCP)? (Select all that apply.)

A) Confirm that a recent chest x-ray is on file
B) Confirm the presence of a consent form
C) Warn patient that the procedure will take about 3 hours
D) Confirm the presence of a prothrombin time/INR
E) Withhold food and drink for 4 hours

Question 48

The nurse clarifies that deterioration progresses through stages before presenting with liver disease. Place the stages in order. (Separate letters by a comma and space as follows: A, B, C, D)

A) Liver disease
B) Inflammation
C) Hepatic insufficiency
D) Destruction
E) Fibrotic regeneration

Question 49

Arrange the normal process of protein metabolism. (Separate letters by a comma and space as follows: A, B, C, D)

A) Protein enters the blood stream
B) Excreted by kidney
C) Portal vein delivers blood to the liver
D) Conversion to urea
E) Ammonia produced in the bowel

Question 50

The disease that is on the increase because of the growing obesity population and is associated with coronary artery disease and use of corticosteroids is_______________.