Deck 35: Nursing Care of Patients With Liver, Pancreatic, and Gallbladder Disorders

Question 1

The employee health nurse is preparing vaccines to administer to patient care staff to permanently protect them from hepatitis.For which types of hepatitis does the nurse have vaccines?

A) HAV
B) HBV
C) HCV
D) Both HAV and HBV

Answer 1

Both HAV and HBV

Question 2

The nurse is collecting data from a patient with acute pancreatitis.Which symptoms should the nurse anticipate?

A) Low abdominal pain, bradycardia, and confusion
B) Shortness of breath, hypotension, and restlessness
C) Fever, tachycardia, right upper quadrant pain, and jaundice
D) Abdominal distention, respiratory distress, and mid-epigastric pain

Answer 2

Abdominal distention, respiratory distress, and mid-epigastric pain

Question 3

The nurse is collecting data for a patient with acute pancreatitis.Which laboratory test result should the nurse expect?

A) Decreased serum lipase
B) Elevated serum amylase
C) Elevated serum albumin
D) Decreased serum ammonia

Answer 3

Elevated serum amylase

Question 4

The nurse is caring for a patient with esophageal varices.Which symptom should alert the nurse to possible bleeding?

A) Asterixis
B) Dark amber urine
C) Hard formed stool
D) Blood-streaked emesis

Question 5

The nurse is collecting data from a patient with liver failure to detect encephalopathy.What instructions should the nurse give to the patient to collect this data?

A) "Stand with your eyes closed."
B) "Hold out your arms and hands."
C) "Kneel on your hands and knees."
D) "Bear down as though you were having a bowel movement."

Question 6

A patient with hepatic encephalopathy is required to consume 50 grams of protein each day.Which item should be provided to the patient for a mid-afternoon snack?

A) Apple
B) Crackers
C) Peanut butter
D) Whole grain bread

Question 7

The nurse is reinforcing discharge teaching about recurrence of pancreatitis to a patient with chronic pancreatitis.What information should the nurse include?

A) Periodic epigastric pain is a normal occurrence.
B) Report anorexia, hyperglycemia, or weight loss.
C) Recurrence of pancreatitis is unlikely to happen.
D) Report jaundice, flatulence, or amber-colored urine.

Question 8

A patient with gallstones asks why jaundice has developed.What should the nurse explain as the most likely cause for the patient's jaundice?

A) Hepatitis
B) Cirrhosis
C) Hemolysis
D) Bile duct obstruction

Question 9

A patient with possible viral hepatitis reports recent intake of raw shellfish.Which type of hepatitis should the nurse consider the patient is experiencing?

A) Hepatitis A virus
B) Hepatitis B virus
C) Hepatitis C virus
D) Hepatitis D virus

Question 10

The nurse is caring for a patient with acute pancreatitis who is vomiting.What should the nurse frequently assess in this patient?

A) Skin color and pain
B) Vital signs and urinary output
C) Bowel sounds and body weight
D) Ability to move lower extremities

Question 11

The nurse is caring for a patient with hepatic encephalopathy.Which prescribed medication should the nurse question before providing to this patient?

A) Vitamin K
B) Neomycin sulfate
C) Diazepam (Valium)
D) Lactulose (Cephulac)

Question 12

A patient with acute pancreatitis is experiencing severe pain.What position should the nurse encourage the patient to assume?

A) Semi-Fowler's position
B) Prone with a pillow under the abdomen
C) Supine with legs elevated and head on a small pillow
D) Sitting in a chair leaning forward with a pillow for back support

Question 13

The nurse is reinforcing teaching provided to a patient with esophageal varices.Which activity should the patient be taught to avoid?

A) Lifting heavy objects
B) Participating in aerobic activities
C) Eating concentrated carbohydrates
D) Rising suddenly from a reclining position

Question 14

A patient with liver failure and esophageal varices is prescribed to receive vasopressin.What should the nurse realize is the purpose for this medication?

A) To promote portal circulation
B) To reduce ammonia buildup and encephalopathy
C) To constrict vessels causing bleeding in esophageal varices
D) To maintain blood pressure in a patient with hypotension related to bleeding varices

Question 15

The nurse is caring for a patient after a liver transplant.Which symptom should the nurse report immediately as a possible indication of rejection of the liver?

A) Pulse rate of 80 beats per minute
B) Prothrombin time (PT) of 14 seconds
C) Decreased alanine aminotransferase (ALT)
D) A temperature greater than 101°F (38.3°C)

Question 16

The nurse is caring for a patient with chronic liver failure.Which laboratory value should the nurse expect as a late sign of liver failure?

A) Low serum albumin
B) Low serum bilirubin
C) Low serum ammonia
D) Low serum aspartate aminotransferase (AST)

Question 17

The nurse is caring for a patient after surgery to drain a pancreatic abscess.Which action should the nurse take to monitor for complications?

A) Document output.
B) Monitor blood glucose.
C) Monitor for hyperproteinemia.
D) Review serum potassium levels.

Question 18

The nurse is reinforcing teaching provided to a patient with a history of acute pancreatitis.Which item should the patient be instructed to avoid?

A) High-sodium foods
B) Alcoholic beverages
C) Carbonated beverages
D) Foods with preservatives

Question 19

The nurse is reinforcing teaching provided to a patient with chronic liver failure.What should the patient be instructed to help prevent injury?

A) "Drink plenty of clear fluids."
B) "Brush your teeth with a soft-bristled brush."
C) "Be sure to get 20 minutes of exercise daily."
D) "Take an aspirin a day to prevent heart complications."

Question 20

The nurse is reinforcing teaching provided to a patient with gallstones.What substance should the nurse instruct that makes up most gallstones?

A) Sodium
B) Calcium
C) Cholesterol
D) Phosphorus

Question 21

A patient with biliary colic is prescribed an anticholinergic medication to help treat biliary colic.For which medical diagnosis should the nurse question the administration of this medication?

A) Asthma
B) Psoriasis
C) Diabetes mellitus
D) Prostatic hypertrophy

Question 22

The nurse is providing a patient with cholelithiasis the medication ursodiol (Actigall).What should the nurse instruct the patient about this medication?

A) This medication is used prior to having surgery.
B) This medication works best with a high-fat diet.
C) This medication may take a few months to work.
D) This medication makes sure the stones never return.

Question 23

A patient with cholecystitis is prescribed promethazine (Phenergan)for nausea.Which adverse effect of the medication should the nurse instruct the patient to report?

A) Diarrhea
B) Insomnia
C) Dry mouth
D) Urine retention

Question 24

The nurse is identifying care to delegate to unlicensed assistive personnel.Which actions could be safely delegated in the care of a patient with fulminant liver failure?

A) Evaluating the patient's mental status
B) Assisting with bathing and positioning
C) Assessing the stool and urine for blood
D) Monitoring laboratory studies for abnormal values

Question 25

A patient has the nursing diagnosis of Deficient Fluid Volume related to anorexia,nausea,vomiting,and excessive T-tube drainage related to cholecystitis.Which interventions should the nurse recommend be included in the plan of care? (Select all that apply.)

A) Monitor skin turgor.
B) Administer antiemetics as ordered.
C) Clamp T-tube for 2 hours each shift.
D) Monitor daily weight and intake and output.
E) Encourage use of incentive spirometer every hour while awake.
F) Contact the physician if T-tube drainage is greater than 150 mL within 24 hours of surgery.

Question 26

A patient with chronic liver disease is prescribed dexlansoprazole (Kapidex).What should the nurse instruct the patient about this medication?

A) Take the entire dose of medication whole.
B) Crush the medication and sprinkle in water.
C) Take this medication with a full glass of milk.
D) Take half the medication with breakfast and the other half with dinner.

Question 27

While collecting data,the nurse becomes concerned that a patient is at risk for developing liver cancer.What information did the nurse use to come to this conclusion? (Select all that apply.)

A) Lives in an urban community
B) Ingests four six-packs of beer each day
C) Smokes two packs of cigarettes each day
D) Has a history of chronic hepatitis B infection
E) Employed as a remote computer operator

Question 28

A patient with liver failure takes acetaminophen (Tylenol)650 mg tablets by mouth for severe arthritis pain.How many tablets should the nurse instruct that the patient can safely take in one 24 hour period?

A) 2
B) 3
C) 4
D) 5

Question 29

The nurse is contributing to the teaching plan for a patient recovering from a cholecystectomy.Which dietary modification should the nurse recommend for the first few weeks after surgery?

A) Decrease intake of fresh fruits and vegetables to minimize pressure on the small intestine.
B) Consume at least four servings of meat, cheese, and peanut butter daily to boost protein intake and aid healing.
C) Distribute fat intake in small portions throughout the day to prevent excessive fat in the intestine at any one time.
D) Take pancreatic enzymes with meals to replace enzymes that would normally have been secreted before the cholecystectomy.

Question 30

The nurse is reinforcing teaching provided to a patient recovering from an acute attack of cholecystitis.Which foods should the nurse caution the patient to avoid? (Select all that apply.)

A) Rice
B) Eggs
C) Cheese
D) Lean meats
E) Fresh fruits

Question 31

The nurse is providing education to a patient recovering from a recent cholecystectomy.What should the nurse include in the teaching? (Select all that apply.)

A) "Fat should be less than 20% of total diet."
B) "Raw fruits and vegetables should be avoided."
C) "It is important to increase the protein intake in your diet."
D) "If you are overweight, it is suggested that you lose weight."
E) "There are no dietary restrictions once you leave the hospital."
F) "Fat is introduced slowly and adjusted according to individual tolerance."

Question 32

The nurse is caring for a patient recovering from an incisional cholecystectomy.Which activities should the nurse identify as having the highest priority for this patient? (Select all that apply.)

A) Managing pain
B) Performing leg exercises
C) Coughing and deep breathing
D) Ambulating early and frequently
E) Choosing low-fat foods from the menu
F) Encouraging use of an incentive spirometer

Question 33

The nurse is collecting data for a patient with acute liver failure.Which laboratory test findings should the nurse recognize as supporting this diagnosis? (Select all that apply.)

A) Elevated platelet count
B) Elevated prothrombin time
C) Elevated serum bilirubin level
D) Elevated serum potassium level
E) Elevated alanine aminotransferase level (ALT)
F) Elevated aspartate aminotransferase level (AST)

Question 34

A patient with cholelithiasis is having clay-colored stools.What should the nurse realize as the most common cause of clay-colored stools?

A) Retrograde bile flow into the liver
B) Accumulation of bile salts in the skin
C) Cirrhosis from chronic liver irritation
D) A gallstone lodged in the common bile duct

Question 35

The nurse is caring for a patient with chronic liver failure.Which medication order should the nurse question?

A) Lactulose
B) Neomycin
C) Multivitamins
D) Acetaminophen

Question 36

The nurse is caring for a patient diagnosed with chronic hepatitisB.Which medications should the nurse anticipate being prescribed for this patient? (Select all that apply.)

A) Interferon alpha-2a
B) Ribavirin (Rebetol)
C) Adefovir (Hepsera)
D) Lamivudine (Epivir)
E) Peginterferon alpha-2b

Question 37

A patient recovering from a cholecystectomy earlier in the day is reluctant to deep breathe and cough.What intervention should the nurse use to assist the patient to cough and breathe?

A) Remind the patient to deep breathe and cough every hour.
B) Teach the patient to use relaxation and distraction techniques.
C) Medicate the patient for pain, and assist to splint the abdomen.
D) Reinforce the importance of the deep breathing and coughing activities.

Question 38

A patient recovering from hepatitis is concerned about liver damage from the infection.What should the nurse instruct the patient to do to prevent long-term liver damage? (Select all that apply.)

A) Get adequate rest.
B) Ingest nutritious foods.
C) Abstain from all alcohol.
D) Restrict physical activity.
E) Limit the intake of dairy products.

Question 39

A patient with pancreatitis is receiving care to address the nursing diagnosis Imbalanced Nutrition: Less than required related to pain,NPO,and nasogastric suction.After 10 days of treatment,which findings should indicate to the nurse that the treatment plan has been effective? (Select all that apply.)

A) The patient reports pain relief.
B) The serum sodium is 130 mEq/L.
C) The patient's albumin level is 3.8 g/L.
D) The serum potassium level is 3.7 mEq/L.
E) The patient has mild diarrhea and steatorrhea.
F) The patient has returned to baseline body weight.

Question 40

The nurse is instructing the mother of an adolescent with hepatitis on ways to prevent the spread of infection in the home.What should the nurse include in this mother's teaching? (Select all that apply.)

A) Use bar soap.
B) Wear rubber gloves when handling the patient's used laundry.
C) Wash contaminated linens separately from other family linens.
D) Identify a separate bedroom and bathroom for the patient to use.
E) Wash gloves with 10% bleach solution after use for cleaning the bathroom.

Question 41

A patient is prescribed to receive 20 mg of metoclopramide (Reglan)intramuscularly (IM).The medication available is 5 mg/ mL.How many mL of the medication should the nurse provide to the patient?