Deck 6: Care of the Patient With a Gallbladder, Liver, Biliary Tract, or Exocrine Pancreatic Disorder

Question 1

Patients with hepatitis A, B, C, D, or E typically are instructed to

A) drink alcohol in moderation.
B) participate in an exercise program.
C) eat a diet low in carbohydrates and high in fat.
D) take vitamin B, C, and K supplements.

Answer 1

take vitamin B, C, and K supplements.

Question 2

In preparation for a cholecystography, the nurse asks if the patient has eaten since midnight. This is done to determine

A) if the patient is hungry.
B) drug allergies.
C) the accuracy of the test.
D) fat intake tolerance.

Answer 2

the accuracy of the test.

Question 3

The new operative procedure gaining in popularity for the removal of the gallbladder, if there is no cholecystitis or choledocholithiasis, is a(n)

A) laparoscopic cholecystectomy.
B) cholangiography.
C) open cholecystectomy.
D) choledochostomy.

Answer 3

laparoscopic cholecystectomy.

Question 4

The nurse can prevent the transmission of hepatitis A by avoiding

A) direct contact through fecal matter, contaminated food, or contaminated water.
B) contaminated blood transfusion.
C) sexual contact and contaminated needles.
D) droplet inhalation.

Question 5

Which abnormal lab value would be found in a patient with a pathological condition of the liver?

A) Hemoglobin
B) Alkaline phosphatase
C) pH 5.0
D) Ca- 125

Question 6

When a patient has hepatic encephalopathy, medications often administered to relieve toxic blood chemistry include:

A) vasopressin, Capoten.
B) milk of magnesia, Metamucil.
C) neomycin, lactulose.
D) HydroDIURIL.

Question 7

Because vitamin K is malabsorbed in the presence of cirrhosis, which laboratory value would be elevated?

A) Hemoglobin
B) Hematocrit
C) Prothrombin time
D) White blood cell count

Question 8

The patient, age 56, has cirrhosis of the liver with severe ascites. The nurse is assisting the physician in the procedure to remove this fluid from his abdominal cavity. This procedure is called an

A) abdominal paracephalus.
B) abdominal paracentesis.
C) abdominal paradentium.
D) abdominal perimetrium.

Question 9

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. The purpose of the T-tube is to

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

Question 10

The patient has cirrhosis of the liver and an albumin/globulin ratio of 0.9 g/dL. The normal ratio is 1.2 to 2.2 g/dL. In collecting objective data for her, the nurse would probably note which outstanding clinical sign?

A) Jaundice
B) Edema
C) Pruritus
D) Pallor

Question 11

Flapping tremor (asterixis) is seen in a patient with

A) Crohn's disease.
B) hepatic encephalopathy.
C) cancer of the stomach.
D) candidiasis.

Question 12

As a result of cirrhosis of the liver, the patient's condition deteriorates and he slips into a hepatic coma. The nurse would anticipate increasing levels of:

A) Amylase
B) Ammonia
C) Thrombocytes
D) Bilirubin

Question 13

The nurse assesses a patient with cholecystitis. Which pain description is typical of biliary colic?

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 shoulder
D) Left upper abdomen, radiating to the jaw and neck

Question 14

After the physician has performed a liver biopsy, the nursing interventions would usually include

A) allowing the patient to get up to use the bathroom if he desires.
B) keeping the patient on the right side for minimum of 2 hours.
C) taking vital signs every 4 hours.
D) keeping the patient on the left side for minimum of 4 hours.

Question 15

Which findings would the nurse expect in a patient with acute pancreatitis?

A) Temperature greater than 102° F (40° C)
B) Blood pressure (systolic) greater than 130 mm Hg
C) Heart rate less than 60 beats per minute
D) Abdominal pain that increases with lying down

Question 16

If the patient has a T-tube in place after a cholecystectomy, the best nursing intervention would be to

A) open the T-tube to air so that it will drain freely.
B) position and secure the drainage bag at the abdominal level.
C) make certain that the tube is tightly taped to the patient near the nipple.
D) irrigate the T-tube with normal saline to ensure the free flow of bile.

Question 17

An essential nursing measure to prevent peritonitis after a paracentesis is

A) thoroughly cleansing the skin of the abdominal wall.
B) examining ascites for bacteria.
C) providing oral or intravenous fluids.
D) maintaining sterile technique during the procedure.

Question 18

The nurse realizes that the patient requires additional teaching about an esophagoscopy after the patient states

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."

Question 19

Infection control is necessary in all areas of the health care setting. Which would be most appropriate in the prevention of hepatitis B in high-risk health workers?

A) Hepatitis B vaccine
B) Maintaining enteric isolation technique
C) Wearing protective gear
D) HBIG injections

Question 20

The patient's cirrhosis of the liver has also caused a dilation of the veins of her lower esophagus secondary to vessel hypertension, resulting in her developing the complications of:

A) Varices
B) Diverticulosis
C) Crohn's disease
D) Achalasia cyst

Question 21

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 22

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. The best intervention would be to

A) notify the physician.
B) unclamp the tube immediately.
C) increase the IV fluids.
D) change the T-tube dressing.

Question 23

What instructions should the patient receive before undergoing a paracentesis?

A) NPO 12 hours before procedure
B) Empty bladder before procedure
C) Strict bed rest after procedure
D) Empty bowel before procedure

Question 24

Which medication would the nurse expect the physician to order postoperatively for a patient who has had a liver transplant?

A) Phenergan
B) Zofran
C) Aspirin
D) Cyclosporine

Question 25

Which would be a major nursing concern to monitor postoperatively in a patient who has had a liver transplant?

A) Drainage
B) Serum electrolytes
C) Infection
D) Urinary retention

Question 26

A patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. The best response would be

A) "The reason you are unable to have anything by mouth is because the physician must examine you."
B) "The pancreas is stimulated whenever you eat or drink and may aggravate your condition."
C) "The pancreas is to be removed surgically. This is the reason you are unable to eat or drink."
D) "The reason you are unable to have anything by mouth is because of diagnostic exams the physician might order."

Question 27

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 28

Esophageal varices can rupture as a result of increases in abdominal venous pressure. Which would increase the abdominal venous pressure? (Select all that apply.)

A) Coughing
B) Swallowing
C) Vomiting
D) Performing the Valsalva maneuver

Question 29

A nursing diagnosis of: Knowledge, deficient, related to relationship of infection to nutritional needs is critical because:

A) The body requires more protein intake to fight infection.
B) The body does not absorb nutrients effectively postoperatively.
C) The body does not require more calories postoperatively.
D) The body requires more parenteral nutrients postoperatively.

Question 30

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 31

The major focus of nursing intervention for the patient with pancreatitis is

A) fluid replacement.
B) electrolyte imbalance.
C) establishing suction.
D) controlling pain.

Question 32

The nurse explains that morphine contraindicated in the patient with pancreatitis because:

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 33

In preparing the patient for a paracentesis, the nurse must be sure

A) the patient is NPO for 12 hours before the procedure.
B) the patient is lying flat in bed for the procedure.
C) the fluid is removed over at least 30 minutes.
D) oral liquids and a light meal are given the evening after the procedure.

Question 34

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 35

Which serum test would a physician order if jaundice was suspected?

A) Cardiac enzymes
B) Liver enzymes
C) Total bilirubin
D) Complete blood count

Question 36

A 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 37

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 38

A patient has been admitted with right upper quadrant pain. Which would most likely be a source of her pain?

A) Spleen
B) Ovaries
C) Gallbladder
D) Pancreas

Question 39

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 40

Carefully monitoring the patient for signs that may indicate the development of pancreatitis (abdominal pain, nausea, and vomiting) is essential after a(n)

A) colonoscopy.
B) endoscopic retrograde cholangiopancreatography (ERCP).
C) upper GI series.
D) Schilling test.

Question 41

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

Question 42

Viral hepatitis may be treated at home. Teach 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.