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

Question 1

When a patient is diagnosed with acute hepatitis B, the nurse will plan to teach the patient about

A) ways to increase exercise and activity level.
B) self-administration of ?-interferon ( Intron A ).
C) side effects of nucleoside and nucleotide analogs.
D) measures that will be helpful in improving appetite.

Answer 1

measures that will be helpful in improving appetite.

Question 2

A 32-year-old patient is diagnosed with early alcoholic cirrhosis. Which topic is most important to include in patient teaching?

A) Need to abstain from alcohol
B) Use of vitamin B supplements
C) Maintenance of a nutritious diet
D) Treatment with lactulose ( Cephulac )

Answer 2

Need to abstain from alcohol

Question 3

When assessing a patient who had a liver transplant a week previously, the nurse obtains the following data. Which finding is most important to communicate to the health care provider?

A) Dry lips and oral mucosa
B) Crackles at both lung bases
C) Temperature 100.8° F ( 38.2° C )
D) No bowel movement for 4 days

Answer 3

Temperature 100.8° F ( 38.2° C )

Question 4

Which nursing action will be included in the plan of care for a patient who is being treated for bleeding esophageal varices with balloon tamponade?

A) Monitor the patient for shortness of breath.
B) Encourage the patient to cough every 4 hours.
C) Deflate the gastric balloon every 8 to 12 hours.
D) Verify the position of the balloon every 6 hours.

Question 5

The health care provider plans a paracentesis for a patient with ascites caused by liver cancer. To prepare the patient for the procedure, the nurse

A) places the patient on NPO status.
B) assists the patient to lie flat in bed.
C) asks the patient to empty the bladder.
D) positions the patient on the right side.

Question 6

The nurse determines that administration of hepatitis B vaccine to a patient has been effective when a specimen of the patient's blood reveals

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

Question 7

Which information given by a patient when the nurse is taking a health history indicates that screening for hepatitis C should be done?

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

Question 8

Which nursing action will be included in the plan of care for a patient with cirrhosis who has ascites and 4+ edema of the feet and legs?

A) Restrict dietary protein intake.
B) Reposition the patient every 4 hours.
C) Use a pressure-relieving mattress.
D) Perform passive range of motion qid.

Question 9

A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate?

A) Schedule the patient for HCV genotype testing.
B) Administer immune globulin and the HCV vaccine.
C) Instruct the patient on ribavirin (Rebetol) treatment.
D) Teach that the infection will resolve in a few months.

Question 10

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

A) "Is there any history of IV drug use?"
B) "Are you taking corticosteroids for any reason?"
C) "Do you use any over-the-counter ( OTC ) drugs?"
D) "Have you recently traveled to a foreign country?"

Question 11

To evaluate the effectiveness of treatment for a patient who has hepatic encephalopathy, which action should the nurse take?

A) Request that the patient stand on one foot.
B) Ask the patient to extend both arms to the front.
C) Instruct the patient to perform the Valsalva maneuver.
D) Have the patient walk a few steps with the eyes closed.

Question 12

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

Question 13

Which of these laboratory test results will be most important for the nurse to monitor when evaluating the effects of therapy for a patient who has acute pancreatitis?

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

Question 14

A patient who has advanced cirrhosis is receiving lactulose ( Cephulac ). Which finding by the nurse indicates that the medication is effective?

A) The patient is alert and oriented.
B) The patient denies nausea or anorexia.
C) The patient's bilirubin level decreases.
D) The patient has at least one stool daily.

Question 15

A patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) has a serum potassium level of 3.2 mEq/L (3.2 mmol/L). Which action should the nurse take?

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

Question 16

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

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

Question 17

Which assessment finding in a patient with acute pancreatitis would the nurse need to report most quickly to the health care provider?

A) Nausea and vomiting
B) Hypotonic bowel sounds
C) Abdominal tenderness and guarding
D) Muscle twitching and finger numbness

Question 18

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

Question 19

After a patient has had a transjugular intrahepatic portosystemic shunt (TIPS) placement, which finding indicates that the procedure has been effective?

A) Lower indirect bilirubin level
B) Increase in serum albumin level
C) Decrease in episodes of variceal bleeding
D) Improvement in alertness and orientation

Question 20

When combination therapy of a-interferon and ribavirin (Rebetol) is being used to treat chronic hepatitis C, the nurse will plan to monitor for

A) leukopenia.
B) hypokalemia.
C) polycythemia.
D) hypoglycemia.

Question 21

A patient is admitted to the hospital with acute cholecystitis. Which assessment information will be most important for the nurse to report to the health care provider?

A) The patient's urine is bright yellow.
B) The patient's stools are clay colored.
C) The patient complains of chronic heartburn.
D) The patient has an increase in pain after eating.

Question 22

The nurse is caring for a patient with chronic hepatitis C infection who has these medications prescribed. Which medication requires further discussion with the health care provider prior to administration?

A) ribavirin (Rebetol, Copegus) 600 mg PO bid
B) pegylated ?-interferon (PEG-Intron, Pegasys) SQ daily
C) diphenhydramine (Benadryl) 25 mg PO every 4 hours PRN itching
D) dimenhydrinate (Dramamine) 50 mg PO every 6 hours PRN nausea

Question 23

A 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?

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

Question 24

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

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

Question 25

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

A) Teach symptoms of variceal bleeding.
B) Discuss the need to increase caloric intake.
C) Review the patient's current medication list.
D) Draw blood for hepatitis serology testing.

Question 26

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

Question 27

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

A) 50-year-old with chronic pancreatitis who has gnawing abdominal pain
B) 48-year-old who has compensated cirrhosis and is complaining of anorexia
C) 45-year-old with cirrhosis and severe ascites who has an oral temperature of 102° F ( 38.8° C )
D) 56-year-old who is recovering from a laparoscopic cholecystectomy and has severe shoulder pain

Question 28

When educating a patient with chronic pancreatitis about the prescribed pancrelipase (Viokase), the nurse will teach the patient to take the medication

A) at bedtime.
B) with every meal.
C) upon arising in the morning.
D) as soon as abdominal pain occurs.

Question 29

A patient with cirrhosis who has been vomiting blood is admitted to the emergency department. Which action should the nurse take first?

A) Insert a large-gauge IV catheter.
B) Draw blood for coagulation studies.
C) Check BP, heart rate, and respirations.
D) Place the patient in the supine position.

Question 30

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

Question 31

A homeless patient with severe anorexia and fatigue is admitted to the hospital with viral hepatitis. Which patient goal has the highest priority when the nurse is developing the plan of care?

A) Increase activity level.
B) Maintain adequate nutrition.
C) Establish a stable home environment.
D) Identify the source of exposure to hepatitis.

Question 32

After providing discharge instructions to a patient following a laparoscopic cholecystectomy, the nurse recognizes that teaching has been effective when the patient states,

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

Question 33

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

A) The apical pulse rate is 68 beats/minute.
B) Stools test negative for occult blood.
C) The patient denies complaints of chest pain.
D) Blood pressure is less than 140/90 mm Hg.

Question 34

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

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

Question 35

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

A) Offer high-calorie, high-protein dietary choices.
B) Offer psychologic support for anxiety or depression.
C) Educate about the need to avoid scratching pruritic areas.
D) Administer prescribed opioids to relieve pain as needed.

Question 36

When the nurse is caring for a patient with acute pancreatitis, which assessment finding is of most concern?

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

Question 37

Which of the following nursing actions included in the plan of care for a patient with cirrhosis can the RN delegate to nursing assistive personnel?

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

Question 38

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

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

Question 39

After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take (select all that apply)?

A) Administer hepatitis B vaccine.
B) Test for antibodies to hepatitis B.
C) Teach about ?-interferon therapy.
D) Give hepatitis B immune globulin.
E) Educate about oral antiviral therapy.

Question 40

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

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