Deck 46: Nursing Management: Liver,pancreas,and Biliary Tract Problems

Question 1

A patient with cirrhosis has an episode of bleeding esophageal varices that is controlled with administration of vasopressin and endoscopic sclerotherapy.To detect possible complications of the bleeding episode,what is it most important for the nurse to monitor?

A) Prothrombin time
B) Serum bilirubin levels
C) Serum ammonia levels
D) Serum potassium levels

Answer 1

Serum ammonia levels

Question 2

Serological testing of a patient reveals the presence of antibodies to the hepatitis C virus (anti-HCV).Which following nursing action is appropriate?

A) Schedule the patient for HCV genotype testing.
B) Teach the patient that the HCV infection will resolve in 2 to 4 months.
C) Administer immunoglobulin and the HCV vaccine.
D) Instruct the patient on self-administration of ?-interferon.

Answer 2

Schedule the patient for HCV genotype testing.

Question 3

The nurse assesses a patient with cirrhosis and finds 4+ pitting edema of the feet and legs and massive ascites.The data indicate that the nurse should monitor which of the following?

A) Temperature
B) Albumin level
C) Hemoglobin
D) Activity level

Answer 3

Albumin level

Question 4

A patient contracts hepatitis from food contaminated by a worker with hepatitis in a fast-food restaurant.During the icteric phase of the patient's illness,what should the nurse expect serological testing to reveal?

A) HBsAg (hepatitis B surface antigen)
B) Anti-HBc IgM (antibody to HBV core antigen)
C) Anti-HAV IgG (antibody to hepatitis A virus,immunoglobulin G)
D) Anti-HAV IgM (antibody to hepatitis A virus,immunoglobulin M)

Question 5

When assessing a patient for signs of impending coma resulting from hepatic encephalopathy,what should the nurse ask the patient to do?

A) Stand on one foot.
B) Extend both arms.
C) Ambulate with the eyes closed.
D) Perform the Valsalva manoeuvre.

Question 6

During evaluation of a patient at an outpatient clinic,the nurse determines that administration of hepatitis B vaccine has been effective when a specimen of the patient's blood reveals which of the following results?

A) HBsAg
B) Anti-HBs (antibody to hepatitis B surface antigen)
C) Anti-HBcAg (antibody to hepatitis B core antigen)
D) Anti-HBc IgM (antibody to hepatitis B core antigen,immunoglobulin M)

Question 7

A patient with cirrhosis has a massive hemorrhage from esophageal varices.In planning care for the patient,to what goal does the nurse give the highest priority?

A) Control of the bleeding
B) Maintenance of the airway
C) Maintenance of fluid volume
D) Relief of the patient's anxiety

Question 8

During treatment of a patient with a Minnesota balloon tamponade for bleeding esophageal varices,what nursing responsibilities should be included?

A) Encourage the patient to cough and breathe deeply.
B) Insert the tube and verify its position every 4 hours.
C) Monitor the patient for shortness of breath.
D) Deflate the gastric balloon every 8 to 12 hours.

Question 9

When lactulose (Cephulac)30 mL four times per day is ordered for a patient with advanced cirrhosis,he complains that it causes diarrhea.The nurse explains to the patient that it is still important for him to take the drug because the drug will create which of the following actions?

A) Promote fluid loss
B) Prevent constipation
C) Prevent gastrointestinal (GI)bleeding
D) Improve nervous system function

Question 10

A physician who has never been immunized for hepatitis B is exposed to the hepatitis B virus (HBV)through a needle stick from an infected patient.What should the infection control nurse inform both the physician and patient that treatment for the exposure should include?

A) Evaluation of liver function tests in 60 days
B) Active immunization with hepatitis B vaccine
C) Hepatitis B immunoglobulin (HBIG)injection
D) Both the hepatitis B vaccine and HBIG

Question 11

A patient with acute hepatitis B asks the nurse if treatment is available for the condition.What should the nurse explain to the patient?

A) Patients with acute hepatitis B can be given HBIG to help reduce the symptoms.
B) A variety of antiviral medications are available to treat acute hepatitis B,but serious side effects limit their use.
C) No medication is available for treatment of HBV infection.
D) Chronic HBV infection can be treated with interferon and lamivudine (Heptovir)and adefovir (Hepsera).

Question 12

While the nurse is obtaining a nursing history from a patient diagnosed with hepatitis C,what information reported by the patient indicates the highest risk factor for hepatitis C?

A) Sexual exposure
B) Injection drug use
C) Eating contaminated shellfish
D) Recent travel to an underdeveloped country

Question 13

A patient with advanced liver disease has marked ascites and signs of hepatic encephalopathy.Following instruction about his diet,the nurse determines that teaching has been effective when the patient's choice of foods from the menu includes which of the following?

A) Cheese omelette with mushrooms and milk
B) Pancakes with butter and honey and orange juice
C) Baked beans with ham,cornbread,sweet potatoes,and coffee
D) Baked chicken with French-fried potatoes,low-protein bread,and tea

Question 14

A person who is homeless is hospitalized with severe anorexia and fatigue.She has mild jaundice and hepatomegaly,and her liver function tests are abnormal.The physician suspects viral hepatitis.In planning care for the patient,to which patient outcome should the nurse assign the highest priority?

A) Maintains adequate nutrition
B) Adapts to changes in appearance
C) Gradually increases tolerance for activity
D) Identifies source of exposure to hepatitis virus

Question 15

A 32-year-old patient has early alcoholic cirrhosis diagnosed by a liver biopsy.In teaching the patient about the disease,it important for the nurse to inform her that the disease may be reversed at this point with which of the following interventions?

A) Vitamin B supplements
B) Abstinence from alcohol
C) Maintenance of a nutritious diet
D) Long-term,low-dose corticosteroids

Question 16

Which hepatitis virus has DNA as its characteristic virus type?

A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis E

Question 17

When teaching a patient recovering from hepatitis B about management of the illness,the nurse determines that additional teaching is needed when the patient makes which of the following statements?

A) "I should not drink alcohol for at least a year."
B) "When I have recovered from this infection,I should have lifelong immunity to the virus."
C) "When the jaundice is gone,I have recovered from my illness and the infection is cured."
D) "I should use a condom during sexual intercourse until my tests for the virus are negative."

Question 18

A 68-year-old patient has an abrupt onset of anorexia,nausea and vomiting,hepatomegaly,and abnormal liver function studies.Serological testing is negative for viral causes of hepatitis.During assessment of the patient,what is it most important for the nurse to ask the patient about?

A) Any prior exposure to people with jaundice
B) The use of all prescription and over-the-counter medications
C) Treatment of chronic diseases with corticosteroids
D) Exposure to children recently immunized for hepatitis B

Question 19

During the acute phase of hepatitis,what would the nurse expect the patient's laboratory results to include?

A) Increased stool urobilinogen
B) Decreased urinary urobilinogen
C) Decreased prothrombin time
D) Increased total serum bilirubin

Question 20

Combination therapy of ?-interferon and ribavirin (Rebetol)is being used to treat hepatitis C in a patient infected with human immunodeficiency virus (HIV).What will the nurse monitor for in the patient?

A) Blood glucose
B) Lymphocyte count
C) Potassium level
D) Serum creatinine

Question 21

When caring for a patient following an incisional cholecystectomy for cholelithiasis,on what patient outcome should the nurse place the highest priority?

A) Turning,coughing,and deep-breathing every 2 hours to prevent respiratory complications
B) Choosing low-fat foods from the menu to prevent weight gain
C) Performing leg exercises every hour while awake to prevent foot drop
D) Ambulating the evening of the operative day to prevent constipation

Question 22

Management of ascites is focused on which one of the following actions?

A) Limiting intake
B) Sodium restriction
C) Administering antibiotics
D) Ensuring adequate rest

Question 23

A patient is admitted with a diagnosis of hepatic encephalopathy with the following symptoms: lethargy,drowsiness,disorientation,asterixic with abnormal reflexes.Which grade on the scale for hepatic encephalopathy would the nurse document for this patient?

A) Grade 1
B) Grade 2
C) Grade 3
D) Grade 4

Question 24

The nurse identifies a nursing diagnosis of risk for impaired skin integrity for a patient with cirrhosis who has ascites and 4+ pitting edema of the feet and legs.What is an appropriate nursing intervention for this problem?

A) Restrict dietary protein intake.
B) Turn the patient every 4 hours.
C) Perform passive range of motion four times per day.
D) Arrange for a special pressure-relieving mattress.

Question 25

The physician prescribes pancreatin (Viokase)for a patient with chronic pancreatitis.The nurse teaches the patient that the drug is considered effective if the patient experiences which of the following findings?

A) Normal stools
B) Decreased jaundice
C) An improved appetite
D) Decreased abdominal pain

Question 26

A patient hospitalized with possible acute pancreatitis has severe abdominal pain and nausea and vomiting.Which of the following elevated serum levels would the nurse expect the diagnosis to be confirmed by?

A) Calcium
B) Bilirubin
C) Potassium
D) Amylase

Question 27

When taking the BP of a patient with severe acute pancreatitis,the nurse notices carpal spasm of the patient's hand.Which action should the nurse take next?

A) Notify the physician immediately.
B) Retake the patient's BP.
C) Check the calcium level on the chart.
D) Ask the patient about any arm pain.

Question 28

A patient with severe cirrhosis has a new prescription for propranolol (Inderal).The nurse will teach the patient that the medication is ordered to do which one of the following?

A) Decrease systemic blood pressure (BP)
B) Prevent the development of ischemia
C) Lower the risk for bleeding varices
D) Reduce fluid retention and edema

Question 29

When interpreting HBV serological profile results,the nurse would anticipate the hepatitis B surface antigen (HBsAg)to be positive in which one of the following circumstances?

A) Chronic infection
B) Immunity from vaccination
C) Past exposure
D) Occult HBV infection

Question 30

When the nurse is caring for a patient with acute pancreatitis,which of these assessment data should be of most concern?

A) Absent bowel sounds
B) Abdominal tenderness
C) Left upper quadrant pain
D) Palpable abdominal mass

Question 31

The nurse knows that levels of which one of the following should be monitored when the patient is receiving adefovir?

A) Potassium
B) Sodium
C) Creatinine
D) Urea

Question 32

Which nursing diagnosis is a priority when the nurse is caring for the patient with pancreatic cancer?

A) Chronic pain related to tumour pressure on abdominal structures
B) Imbalanced nutrition: less than required related to anorexia
C) Impaired skin integrity related to itching secondary to jaundice
D) Grieving related to potentially terminal diagnosis

Question 33

A shunting procedure is considered for a patient with cirrhosis following an episode of bleeding esophageal varices.The nurse understands which of the following about these procedures?

A) They improve patient survival rates.
B) They increase the risk of hepatic encephalopathy.
C) They require surgery to redirect blood flow around the liver.
D) They are first-line therapies for portal hypertension and esophageal varices.

Question 34

When providing discharge instructions to a patient following a laparoscopic cholecystectomy at an outpatient surgical centre,the nurse recognizes that teaching has been effective when the patient makes which of the following comments?

A) "I should plan to limit my activities and not return to work for 4 to 6 weeks."
B) "I can expect some reddish yellow drainage from the incisions for a few days."
C) "I should remove the bandages on my incisions tomorrow and take a shower."
D) "I will always need to maintain a low-fat diet because I no longer have a gallbladder."

Question 35

The nurse identifies the collaborative problem of "potential complication: electrolyte imbalance" for a patient with severe acute pancreatitis.What assessment findings would alert the nurse to electrolyte imbalances associated with acute pancreatitis?

A) Hypotension
B) Hyperglycemia
C) Muscle cramps and tetany
D) Paralytic ileus and abdominal distension

Question 36

In planning care for a patient with acute pancreatitis,to which of the following patient outcomes would the nurse assign the highest priority?

A) Develops no complications
B) Maintains normal respiratory function
C) Expresses satisfaction with pain control
D) Maintains adequate fluid and electrolyte balance

Question 37

A patient is admitted to the hospital with a sudden onset of severe right upper quadrant pain that radiates to the right shoulder.She has a history of fat intolerance and heartburn.The nurse recognizes that the patient most likely has a biliary tract obstruction when the patient reports experiencing which of the following?

A) Spider angiomas
B) Clay-coloured stools
C) Dilute,bright-yellow urine
D) Epigastric pain relieved by vomiting

Question 38

Which data obtained by the nurse during the assessment of a patient with cirrhosis will be of most concern?

A) The patient's skin has multiple spider-shaped blood vessels on the abdomen.
B) The patient has ascites and a 2-kg weight gain from the previous day.
C) The patient complains of right upper quadrant pain with abdominal palpation.
D) The patient's hands flap back and forth when the arms are extended.

Question 39

A patient with cancer of the liver has severe ascites that is causing shortness of breath and difficulty breathing.The physician plans a paracentesis to relieve the fluid pressure on the diaphragm.To prepare the patient for the procedure,what should the nurse do?

A) Ask the patient to empty the bladder.
B) Position the patient flat on the right side.
C) Obtain informed consent for the procedure.
D) Have the patient lie flat with a small pillow under the small of the back.

Question 40

When obtaining a health history from a patient with acute pancreatitis,what history should the nurse specifically ask the patient about?

A) Smoking
B) Alcohol use
C) Diabetes mellitus
D) High-fat dietary intake