Question 1

The nurse is caring for a 73-year-old man who has cirrhosis.Which data obtained by the nurse during the assessment will be of most concern?

Accepted Answer

Asterixis indicates that the patient has hepatic encephalopathy,and hepatic coma may occur.The spider angiomas and right upper quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment.The ascites and weight gain indicate the need for treatment but not as urgently as the changes in neurologic status.

Question 2

Which response by the nurse best explains the purpose of ranitidine (Zantac)for a patient admitted with bleeding esophageal varices?

Accepted Answer

Esophageal varices are dilated submucosal veins.The therapeutic action of H?-receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acid gastric contents.Although ranitidine does decrease the risk for peptic ulcers,reduce nausea,and help prevent aspiration pneumonia,these are not the primary purposes for H?-receptor blockade in this patient.

Question 3

Which action should the nurse in the emergency department take first for a new patient who is vomiting blood?

Accepted Answer

The nurse's first action should be to determine the patient's hemodynamic status by assessing vital signs.Drawing blood for coagulation studies and inserting an IV catheter are also appropriate.However,the vital signs may indicate the need for more urgent actions.Because aspiration is a concern for this patient,the nurse will need to assess the patient's vital signs and neurologic status before placing the patient in a supine position.

Question 4

A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal).Which finding is the best indicator that the medication has been effective?

Accepted Answer

Because the purpose of â-blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices,the best indicator of the effectiveness for propranolol is the lack of blood in the stools.Although propranolol is used to treat hypertension,angina,and tachycardia,the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices.

Question 5

When taking the blood pressure (BP)on the right arm of a patient with severe acute pancreatitis,the nurse notices carpal spasms of the patient's right hand.Which action should the nurse take next?

Accepted Answer

The patient with acute pancreatitis is at risk for hypocalcemia,and the assessment data indicate a positive Trousseau's sign.The health care provider should be notified after the nurse checks the patient's calcium level.There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.

Question 6

The nurse is caring for a 36-year-old patient with pancreatic cancer.Which nursing action is the highest priority?

Accepted Answer

Effective pain management will be necessary in order for the patient to improve nutrition,be receptive to teaching,or manage anxiety or depression.

Question 7

Which assessment finding is of most concern for a 46-year-old woman with acute pancreatitis?

Accepted Answer

A palpable abdominal mass may indicate the presence of a pancreatic abscess,which will require rapid surgical drainage to prevent sepsis.Absent bowel sounds,abdominal tenderness,and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

Question 8

Which assessment information will be most important for the nurse to report to the health care provider about a patient with acute cholecystitis?

Accepted Answer

Tan or grey stools indicate biliary obstruction,which requires rapid intervention to resolve.The other data are not unusual for a patient with this diagnosis,although the nurse would also report the other assessment information to the health care provider.

Question 9

A 34-year old patient with chronic hepatitis C infection has several medications prescribed.Which medication requires further discussion with the health care provider before administration?

Accepted Answer

Pegylated á-interferon is administered weekly.The other medications are appropriate for a patient with chronic hepatitis C infection.

Question 10

Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)?

Accepted Answer

Some medications can increase the risk for NAFLD,and they should be eliminated.NAFLD is not associated with hepatitis,weight loss is usually indicated,and variceal bleeding would not be a concern in a patient with asymptomatic NAFLD.

Question 11

The nurse is planning care for a 48-year-old woman with acute severe pancreatitis.The highest priority patient outcome is

Accepted Answer

Respiratory failure can occur as a complication of acute pancreatitis,and maintenance of adequate respiratory function is the priority goal.The other outcomes would also be appropriate for the patient.

Question 12

Which goal has the highest priority in the plan of care for a 26-year-old homeless patient admitted with viral hepatitis who has severe anorexia and fatigue?

Accepted Answer

The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration.Finding a home for the patient and identifying the source of the infection would be appropriate activities,but they do not have as high a priority as ensuring adequate nutrition.Although the patient's activity level will be gradually increased,rest is indicated during the acute phase of hepatitis.

Question 13

During change-of-shift report,the nurse learns about the following four patients.Which patient requires assessment first?

Accepted Answer

This patient's history and fever suggest possible spontaneous bacterial peritonitis,which would require rapid assessment and interventions such as antibiotic therapy.The clinical manifestations for the other patients are consistent with their diagnoses and do not indicate complications are occurring.

Question 14

The nurse will teach a patient with chronic pancreatitis to take the prescribed pancrelipase (Viokase)

Accepted Answer

Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal.

Question 15

The nurse recognizes that teaching a 44-year-old woman following a laparoscopic cholecystectomy has been effective when the patient states which of the following?

Accepted Answer

After a laparoscopic cholecystectomy,the patient will have Band-Aids in place over the incisions.Patients are discharged the same (or next)day and have few restrictions on activities of daily living.Drainage from the incisions would be abnormal,and the patient should be instructed to call the health care provider if this occurs.A low-fat diet may be recommended for a few weeks after surgery but will not be a life-long requirement.

Question 16

The nurse will ask a 64-year-old patient being admitted with acute pancreatitis specifically about a history of

Accepted Answer

Alcohol use is one of the most common risk factors for pancreatitis in the United States.Cigarette smoking,diabetes,and high-protein diets are not risk factors.

Question 17

A 67-year-old male patient with acute pancreatitis has a nasogastric (NG)tube to suction and is NPO.Which information obtained by the nurse indicates that these therapies have been effective?

Accepted Answer

NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain.Although bowel sounds may be hypotonic with acute pancreatitis,the presence of bowel sounds does not indicate that treatment with NG suction and NPO status has been effective.Electrolyte levels may be abnormal with NG suction and must be replaced by appropriate IV infusion.Although Grey Turner sign will eventually resolve,it would not be appropriate to wait for this to occur to determine whether treatment was effective.

Question 18

For a patient with cirrhosis,which of the following nursing actions can the registered nurse (RN)delegate to unlicensed assistive personnel (UAP)?

Accepted Answer

Providing oral hygiene is within the scope of UAP.Assessments and assisting patients to choose therapeutic diets are nursing actions that require higher-level nursing education and scope of practice and would be delegated to licensed practical/vocational nurses (LPNs/LVNs)or RNs.

Question 19

A 51-year-old woman had an incisional cholecystectomy 6 hours ago.The nurse will place the highest priority on assisting the patient to

Accepted Answer

Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing.The other nursing actions are also important to implement but are not as high a priority as ensuring adequate ventilation.

Question 20

Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B?

Accepted Answer

Patients with chronic hepatitis are at higher risk for development of liver cancer,and should be screened for liver cancer every 6 to 12 months.Patients with chronic hepatitis are advised to completely avoid alcohol.There is no hepatitis C vaccine.Because anti-HBs is present whenever there has been a past hepatitis B infection or vaccination,there is no need to regularly monitor for this antibody.

Quiz 40: Nursing Management: Liver,pancreas and Biliary Tract Problems