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

Question 1

The nurse is reinforcing teaching for a patient with a history of acute pancreatitis. The patient should be taught to avoid which of the following foods?

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

Answer 1

Alcoholic beverages

Question 2

The nurse is caring for a patient with acute pancreatitis with severe pain. What position should the nurse encourage the patient to assume?

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

Answer 2

Sitting in a chair leaning forward with a pillow for back support

Question 3

The nurse is caring for a patient who has chronic liver failure. The nurse would recognize which of the following laboratory results as a late sign of liver failure?

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

Answer 3

Low serum albumin

Question 4

The nurse is reinforcing teaching for a patient with chronic liver failure. Which of the following instructions should be given to help prevent injury?

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

Question 5

A patient with possible viral hepatitis reports recent intake of raw shellfish. Which of these types of hepatitis does the patient most likely have?

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

Question 6

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

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

Question 7

The nurse is caring for a patient who has esophageal varices. Which of the following symptoms should alert the nurse to possible bleeding?

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

Question 8

The nurse is caring for a patient who has jaundice due to a gallstone. The patient asks, "What is causing my jaundice?" The nurse would recognize that which of the following is the most likely cause?

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

Question 9

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

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

Question 10

The nurse is caring for a patient who has liver failure and esophageal varices. The patient is to receive vasopressin (Pitressin) for which of the following purposes?

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

Question 11

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

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

Question 12

The nurse is caring for a patient who has hepatic encephalopathy. If the following medications were ordered, what drug would the nurse question?

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

Question 13

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

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

Question 14

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

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

Question 15

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

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

Question 16

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

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

Question 17

Permanent, active immunity is available by vaccine against which type(s) of hepatitis?

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

Question 18

The nurse is caring for a patient with acute pancreatitis who is vomiting. It would be important for the nurse to frequently assess which of the following?

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

Question 19

A patient with hepatic encephalopathy is placed on a low-protein diet. Which of the following items is best to offer the patient for a mid-afternoon snack?

A)Peanut butter
B)Apple
C)Whole grain bread
D)Cheese and crackers

Question 20

The nurse is reinforcing teaching for a patient with gallstones. The nurse would base teaching on understanding that which substance makes up most gallstones?

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

Question 21

The nurse contributes to the plan of care for a patient who has pancreatitis. A nursing diagnosis of Imbalanced Nutrition: Less Than Required related to pain, NPO, and nasogastric suction is developed. After 10 days of treatment, which of the following would indicate to the nurse that the treatment plan has been effective? (Select all that apply.?

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

Question 22

The nurse is providing education for a patient who had a recent cholecystectomy. Which of the following should the nurse include in the teaching? (Select all that apply.?

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

Question 23

The nurse is reinforcing teaching for a patient who had an acute attack of cholecystitis.The patient should be cautioned to avoid which of these foods? (Select all that apply.?

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

Question 24

The nurse is contributing to the teaching plan. Which dietary modification should the nurse recommend during the first few weeks after a cholecystectomy?

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 25

The nurse is collecting data for a patient with cholelithiasis who is found to have clay-colored stools. Which of these does the nurse recognize is the most common cause of clay-colored stools?

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

Question 26

Which of the following nursing interventions could be safely delegated to a nursing assistant assisting in the care of a patient with fulminant liver failure?

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

Question 27

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

Question 28

The nurse is caring for a patient who had an incisional cholecystectomy. Which activities should the nurse prioritize highest? (Select all that apply.?

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

Question 29

T-tube drainage of about 250 to ________________mL of yellowish-green bile is common within the first 24 hours after cholecystectomy.

Question 30

The nurse is caring for a patient who had a cholecystectomy this morning. The patient is reluctant to deep breathe and cough. What nursing intervention would most effectively assist the patient to cough and breathe?

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

Question 31

The nurse is caring for a patient who is being medicated with promethazine (Phenergan) to reduce nausea associated with cholecystitis. The patient should be cautioned to report which of the following side effects?

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

Question 32

The nurse is caring for a patient who has chronic liver failure. Which of the following medication orders should the nurse question?

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

Question 33

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

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

Question 34

The nurse must administer 20 mg of metoclopramide (Reglan) IM. It is supplied as 5 mg per mL. The nurse should administer ________________mL.

Question 35

The nurse is reinforcing teaching for a patient recently diagnosed with hepatitis G (HGV). Which of the following should be included in the teaching? (Select all that apply.?

A)"The virus can be transmitted through sexual contact, so it is important to use a condom with intercourse."
B)"Normal liver function often resumes after the initial infection if no complications occur."
C)"This virus is airborne, so you will need to wear a mask until you've been on antibiotics for 5 days."
D)"The infection is most commonly associated with contaminated seafood products."
E)"This form of hepatitis is thought to cause mild illness in most cases."
F)"Children in day care are at increased risk for this illness."
Completion
Complete each statement.

Question 36

A nurse is preparing to administer the prescribed medication propantheline bromide (Pro-Banthine) to a patient with biliary colic associated with acute cholecystitis. The nurse would be most concerned if the patient had which of the following diagnoses?

A)Diabetes mellitus
B)Prostatic hypertrophy
C)Asthma
D)Psoriasis
Multiple Response
Identify one or more choices that best complete the statement or answer the question.