Deck 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems

Question 1

A homeless patient with severe anorexia, fatigue, jaundice, and hepatomegaly is diagnosed with viral hepatitis and has just been admitted to the hospital. In planning care for the patient, the nurse assigns the highest priority to the patient outcome of

A) maintaining adequate nutrition.
B) establishing a stable home environment.
C) increasing activity level.
D) identifying the source of exposure to hepatitis.

Answer 1

maintaining adequate nutrition.

Question 2

A health care provider who has not been immunized for hepatitis B is exposed to the hepatitis B virus (HBV) through a needle stick from an infected patient. The infection control nurse informs the individual that treatment for the exposure should include

A) baseline hepatitis B antibody testing now and in 2 months.
B) active immunization with hepatitis B vaccine.
C) hepatitis B immune globulin (HBIG) injection.
D) both the hepatitis B vaccine and HBIG injection.

Answer 2

both the hepatitis B vaccine and HBIG injection.

Question 3

When taking a health history for a new patient, which information given by the patient would indicate that screening for hepatitis C is appropriate?

A) The patient had a blood transfusion after surgery in 1998.
B) The patient reports a one-time use of IV drugs 20 years ago.
C) The patient eats frequent meals in fast-food restaurants.
D) The patient recently traveled to an undeveloped country.

Answer 3

The patient reports a one-time use of IV drugs 20 years ago.

Question 4

When teaching a patient recovering from hepatitis B about management of the illness, the nurse determines that additional teaching is needed when the patient says

A) "I should not drink alcohol for at least the next year."
B) "My family members should be tested for hepatitis B."
C) "When the jaundice is gone, I have recovered from my illness and the infection is cured."
D) "Until my tests for the virus are negative, I should use a condom for sexual intercourse."

Question 5

When assessing the neurologic status of a patient with a diagnosis of hepatic encephalopathy, the nurse asks the patient to

A) stand on one foot.
B) ambulate with the eyes closed.
C) extend both arms.
D) perform the Valsalva maneuver.

Question 6

A patient in the outpatient clinic has positive serologic testing for anti-HCV. Which action by the nurse is appropriate?

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

Question 7

A patient with cirrhosis has 4+ pitting edema of the feet and legs and massive ascites. The data indicate that it is most important for the nurse to monitor the patient's

A) temperature.
B) albumin level.
C) hemoglobin.
D) activity level.

Question 8

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. An appropriate nursing intervention for this problem is to

A) restrict dietary protein intake.
B) arrange for a pressure-relieving mattress.
C) perform passive range of motion QID.
D) turn the patient every 4 hours.

Question 9

A patient with cirrhosis has a massive hemorrhage from esophageal varices. In planning care for the patient, the nurse gives the highest priority to the goal of

A) controlling bleeding.
B) maintenance of the airway.
C) maintenance of fluid volume.
D) relieving the patient's anxiety.

Question 10

During treatment of a patient with a Minnesota balloon tamponade for bleeding esophageal varices, which nursing action will be included in the plan of care?

A) Encourage the patient to cough and deep breathe.
B) Insert the tube and verify its position q4hr.
C) Monitor the patient for shortness of breath.
D) Deflate the gastric balloon q8-12hr.

Question 11

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

A) HBsAg.
B) anti-HBs.
C) anti-HBc IgM.
D) anti-HBc IgG

Question 12

A patient is admitted with an abrupt onset of jaundice, nausea and vomiting, hepatomegaly, and abnormal liver function studies. Serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate?

A) "Have you been around anyone with jaundice?"
B) "Do you use any prescription or over-the-counter (OTC) drugs?"
C) "Are you taking corticosteroids for any reason?"
D) "Is there any history of IV drug use?"

Question 13

A patient with severe cirrhosis has an episode of bleeding esophageal varices. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor

A) prothrombin time.
B) bilirubin levels.
C) ammonia levels.
D) potassium levels.

Question 14

A patient who is admitted with acute hepatic encephalopathy and ascites receives instructions about appropriate diet. The nurse determines that the teaching has been effective when the patient's choice of foods from the menu includes

A) an omelet with cheese and mushrooms and milk.
B) pancakes with butter and honey and orange juice.
C) baked beans with ham, cornbread, potatoes, and coffee.
D) baked chicken with french-fries, low-fiber bread, and tea.

Question 15

A patient with cirrhosis who is being treated with spironolactone (Aldactone) and furosemide (Lasix) has a serum sodium level of 135 mEq/L (135 mmol/L) and serum potassium 3.2 mEq/L (3.2 mmol/L). Before notifying the health care provider, the nurse should

A) administer the furosemide and withhold the spironolactone.
B) give both drugs as scheduled.
C) administer the spironolactone.
D) withhold both drugs until talking with the health care provider.

Question 16

A 32-year-old patient has early alcoholic cirrhosis diagnosed by a liver biopsy. When planning patient teaching, the priority information for the nurse to include is the need for

A) vitamin B supplements.
B) abstinence from alcohol.
C) maintenance of a nutritious diet.
D) long-term, low-dose corticosteroids.

Question 17

A patient with acute hepatitis B asks the nurse if treatment is available for the condition. The nurse explains to the patient that

A) because no medication is available to treat acute viral hepatitis, adequate nutrition and rest are the most important treatments.
B) lamivudine (Epivir) can decrease viral load and liver damage in patients with acute hepatitis B, but it must be taken for at least 1 year.
C) patients with acute hepatitis B can be given HBIG to help reduce the symptoms.
D) various antiviral drugs are available to treat acute hepatitis B, but serious side effects limit their use.

Question 18

When lactulose (Cephulac) 30 ml QID is ordered for a patient with advanced cirrhosis, the patient complains that it causes diarrhea. The nurse explains to the patient that it is still important to take the drug because the lactulose will

A) promote fluid loss.
B) prevent constipation.
C) prevent gastrointestinal (GI) bleeding.
D) improve nervous system function.

Question 19

A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal

A) hepatitis B surface antigen (HBsAg).
B) anti-hepatitis B core immunoglobulin M (anti-HBc IgM).
C) anti-hepatitis A virus immunoglobulin G (anti-HAV IgG).
D) anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).

Question 20

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

A) blood glucose.
B) lymphocyte count.
C) potassium level.
D) serum creatinine.

Question 21

The health care provider prescribes pancreatin (Viokase) for a patient with chronic pancreatitis. The nurse teaches the patient that the drug is considered effective if the patient experiences

A) normal-appearing stools.
B) decreased jaundice.
C) improved appetite.
D) reduced abdominal pain.

Question 22

A patient who is admitted to the hospital with a sudden onset of severe right upper-quadrant pain that radiates to the right shoulder is diagnosed with cholecystitis. Which assessment information will be most important for the nurse to report to the health care provider?

A) The patient has an increase in pain after eating.
B) The patient needs 4 mg of morphine for pain relief.
C) The patient's stools are clay colored.
D) The patient's urine is bright yellow.

Question 23

Which of these nursing actions included in the plan of care for a patient with cirrhosis can the nurse delegate to a nursing assistant?

A) Assessing the patient for jaundice
B) Assisting the patient in choosing the diet
C) Palpating the abdomen for distention
D) Providing oral hygiene before meals

Question 24

When the nurse is caring for the patient with pancreatic cancer, which nursing diagnosis is a priority?

A) Chronic pain related to tumor 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 25

A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. The nurse explains to the patient that the major purpose of this treatment is

A) control of fluid and electrolyte imbalance.
B) relief from nausea and vomiting.
C) reduction of pancreatic enzymes.
D) removal of the precipitating irritants.

Question 26

A patient with end-stage liver disease who is to undergo a liver transplant tells the nurse, "I have a friend who has already rejected two kidney transplants. I am concerned that I will reject this liver." The nurse's best response to the patient is

A) "Perhaps your friend did not have a good tissue match with the kidney transplants."
B) "You would not be scheduled for a transplant if there was a concern about rejection."
C) "The problem of rejection is not as common in liver transplants as in kidney transplants."
D) "It is easier to get a good tissue match with liver transplants than with kidney transplants."

Question 27

A patient hospitalized with possible acute pancreatitis has severe abdominal pain and nausea and vomiting. The nurse would expect the diagnosis to be confirmed with laboratory testing that reveals elevated serum

A) calcium.
B) bilirubin.
C) amylase.
D) potassium.

Question 28

When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about a history of

A) cigarette smoking.
B) alcohol use.
C) diabetes mellitus.
D) high-protein diet.

Question 29

An appropriate collaborative problem for the nurse to include in the care plan for a patient with cholelithiasis and obstruction of the common bile duct is

A) potential complication: bleeding.
B) potential complication: gastritis.
C) potential complication: thromboembolism.
D) potential complication: biliary cirrhosis.

Question 30

The nurse identifies the collaborative problem of potential complication: electrolyte imbalance for a patient with severe acute pancreatitis. Assessment findings that alert the nurse to electrolyte imbalances associated with acute pancreatitis include

A) muscle twitching and finger numbness.
B) paralytic ileus and abdominal distention.
C) hypotension.
D) hyperglycemia.

Question 31

A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse is the best indicator that these therapies have been effective?

A) Bowel sounds are present.
B) Abdominal pain is decreased.
C) Electrolyte levels are normal.
D) Grey Turner sign resolves.

Question 32

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

A) decrease systemic BP.
B) prevent the development of ischemia.
C) lower the risk for bleeding varices.
D) reduce fluid retention and edema.

Question 33

A patient who was admitted with acute bleeding from esophageal varices asks the nurse the purpose for the ordered ranitidine (Zantac). Which response by the nurse is most appropriate?

A) The medication will inhibit the development of gastric ulcers.
B) The medication will prevent irritation to the esophageal varices.
C) The medication will decrease nausea and anorexia.
D) The medication will reduce the risk for aspiration.

Question 34

In planning care for a patient with acute pancreatitis, the nurse assigns the highest priority to the patient outcome of

A) developing no acute complications.
B) maintenance of normal respiratory function.
C) expressing satisfaction with pain control.
D) having adequate fluid and electrolyte balance.

Question 35

A patient with cancer of the liver has severe ascites, and the health care provider plans a paracentesis to relieve the fluid pressure on the diaphragm. To prepare the patient for the procedure, the nurse

A) asks the patient to empty the bladder.
B) positions the patient on the right side.
C) obtains informed consent for the procedure.
D) assists the patient to lie flat in bed.

Question 36

When providing discharge instructions to a patient following a laparoscopic cholecystectomy at an outpatient surgical center, the nurse recognizes that teaching has been effective when the patient states,

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 can remove the bandages on my incisions tomorrow and take a shower."
D) "I will always need to maintain a low-fat diet since I no longer have a gallbladder."

Question 37

When caring for a patient following an incisional cholecystectomy for cholelithiasis, the nurse places the highest priority on assisting the patient to

A) turn, cough, and deep breathe every 2 hours.
B) choose low-fat foods from the menu.
C) perform leg exercises hourly while awake.
D) ambulate the evening of the operative day.

Question 38

A portocaval shunt is considered for a patient with cirrhosis following an episode of bleeding esophageal varices. The nurse plans to teach the patient that this procedure

A) is likely to improve the patient's life expectancy.
B) will increase the risk of hepatic encephalopathy.
C) will help to decrease the incidence of peritonitis.
D) is a first-line therapy for portal hypertension.

Question 39

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 40

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 health care provider immediately.
B) Retake the patient's blood pressure.
C) Check the calcium level on the chart.
D) Ask the patient about any arm pain.

Question 41

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