Deck 38: Caring for the Patient With Hepatic and Biliary Disorders

Question 1

A patient with pancreatitis asks the nurse, "Why are my stools so frothy and smell so bad?" What is the nurse's best response?

A) "This is a sign of malnutrition."
B) "This indicates your stools have more fat in them."
C) "This is a sign of peptic ulcer disease."
D) "You may be developing diabetes mellitus."

Answer 1

"This indicates your stools have more fat in them."

Question 2

Which finding in a patient who has a Sengstaken-Blakemore tube for esophageal varices is the priority for follow-up?

A) Left lower leg swollen and reddened
B) Absent bowel sounds to lower-left quadrant
C) Decreased level of consciousness
D) 3 cm darkened area on left heel

Answer 2

Decreased level of consciousness

Question 3

The nurse is caring for a patient with severe liver disease. The nurse notes new ecchymotic areas on the patient's arms and legs. Which laboratory results will the nurse analyze regarding this finding? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Complete blood count
B) Coagulation studies
C) Serum albumin
D) Serum ammonia levels
E) Serum hepatitis antibodies

Answer 3

Complete blood count
Coagulation studies

Question 4

A patient who reports a severe, steady pain in the epigastric area along with nausea and vomiting states, "This happens every time I eat barbecued ribs. It will go away in a little while, especially if I lie on my back." The nurse would consider which disorder as the likely cause of these symptoms?

A) Porcine allergy
B) Obesity
C) Cholelithiasis
D) Pancreatitis

Question 5

The nurse is caring for a patient with cholelithiasis who has a new laboratory finding of serum amylase of 300 units/L. The patient states, "My primary health care provider said I don't have pancreatitis." What is the most likely explanation for the laboratory finding?

A) The gallstone is causing acute cholecystitis.
B) The gallstone has migrated to the neck of the pancreas.
C) The gallstone has caused bile to back into the pancreas.
D) The gallstone is blocking the common bile duct.

Question 6

Which outcome should receive priority in the care plan for a patient who has had a paracentesis to treat ascites?

A) The patient will have normal bilateral breath sounds.
B) The patient's spleen will not rupture.
C) The patient's respiratory effort will be lessened.
D) The patient will not manifest symptoms of hepatomegaly.

Question 7

The nurse has given a patient instruction about the possible complications of unresolved cholecystitis. Which statements by the patient would indicate correct understanding of the instruction? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "I could have infected pus stored in my gallbladder."
B) "My gallbladder could rot and cause a big infection in my abdomen."
C) "My gallbladder trouble could become chronic."
D) "My cholesterol could get very high."
E) "My gallbladder could turn inside out into the bile duct."

Question 8

The nurse should instruct the patient with a diagnosis of cholelithiasis to make which lifestyle modification to alleviate symptoms?

A) Reduce sodium intake.
B) Increase fluids.
C) Reduce smoking.
D) Reduce fat consumption.

Question 9

The nurse assesses a patient who is reporting epigastric pain. The patient's serum amylase level is 369 units/L. What is the nurse's best action?

A) Continue to monitor the patient.
B) Refer the patient to a dietician.
C) Contact the primary health care provider.
D) Question the patient regarding alcohol use patterns.

Question 10

The clinic nurse has been providing care for a patient with a long history of cholelithiasis. Which statement by the patient would make the nurse suspicious that the condition has progressed to cholecystitis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "I was in terrible pain for 2 hours, but then it went away."
B) "I'm hot and sweating, and then cold and shivering."
C) "The pain's in the same location as when I had appendicitis."
D) "I need an emesis basin; I've vomited four times."
E) "My abdomen and my back both hurt."

Question 11

The nurse should include which teaching points when planning discharge for a patient who has a T-tube following a cholecystectomy? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Keep the skin around the site clean and free from bile drainage.
B) Report drainage of more than 500 mL per day to the health care provider.
C) Primarily maintain a side-lying position to facilitate drainage.
D) Report skin redness or irritation in the drain site area.
E) Pin the drainage tube to clothing to maintain slight traction on the site.

Question 12

A patient has chronic pancreatitis and a serum amylase level of 180 units/L. The nurse should instruct the patient to follow which dietary plan?

A) Low residue, no alcohol
B) Low fat, no alcohol
C) Low fat, no fiber
D) Mechanical soft

Question 13

Which teaching point is appropriate for a nurse to include when teaching a patient who has undergone a liver transplant?

A) "Your immunosuppressive medications may cause weight loss."
B) "Reduce scheduled tacrolimus to every other day if nausea occurs."
C) "Take acetaminophen Tylenol) if fever develops."
D) "Report sore throats to your health care provider."

Question 14

A patient who has portal system encephalopathy is receiving Neomycin neomycin sulfate). Which manifestation would indicate to the nurse that the patient's condition is improving?

A) An increase in the potassium level
B) Asterixis
C) Relief of jaundice
D) Increased level of consciousness

Question 15

A patient asks the nurse about ways to reduce the risk of developing gallstones and cholecystitis. The nurse should discuss which health promotion activities? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Walk for 30 minutes five times a week.
B) Eat a low-fiber, high-calorie diet.
C) Eat a low-cholesterol diet.
D) Eat large amounts of citrus fruits.
E) Lose weight as rapidly as possible.

Question 16

The nurse is teaching a patient about strategies for reducing the risk of hepatitis B transmission. Which statements by the patient indicate understanding of the nurse's instruction? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "I will wash my hands frequently to prevent fecal-oral transmission."
B) "I will avoid alcohol."
C) "I will avoid contact with blood and body fluids."
D) "I will avoid contaminated food and water."
E) "I will use safe sex techniques."

Question 17

A patient with hepatitis has a prescription for alpha interferon. Which manifestation would indicate that the patient is experiencing an untoward effect of this medication?

A) Jaundice
B) Flulike syndrome
C) Gallbladder pain
D) Clay-colored stools

Question 18

The nurse assesses a patient with cirrhosis who is experiencing hypertension, edema, and shortness of breath. Which nursing diagnosis will the nurse establish?

A) Fluid Volume Deficit
B) Ineffective Tissue Perfusion
C) Fluid Volume Excess
D) Impaired Skin Integrity

Question 19

When assessing a patient who has cirrhosis, which finding would best indicate the patient is developing ascites?

A) Accumulation of fluid in the abdomen
B) Yellow skin
C) Ecchymosis
D) Upper-right-quadrant pain

Question 20

The nurse assesses a patient who has cirrhosis secondary to liver failure. Which finding would require immediate follow-up by the nurse?

A) Asterixis
B) Jaundice
C) Increased abdominal girth
D) Dyspnea

Question 21

A patient admitted with acute pancreatitis has a nasogastric tube, is in pain, and is on bed rest. The patient says, "I don't understand why I can't eat." How should the nurse respond?

A) Start the patient on a small amount of clear liquids.
B) Explain the purpose of the nasogastric tube and the reasons for keeping the patient NPO.
C) Tell the patient that pain medication is limited to prevent addiction.
D) Tell the patient that IV fluids are sufficient for now.

Question 22

A patient with end-stage pancreatic cancer is admitted to the nursing unit. The patient is lethargic and jaundiced. What is the priority nursing care for this patient?

A) Manage nutrition.
B) Increase activity.
C) Manage comfort.
D) Understand the effects of high bilirubin levels.

Question 23

A patient arrives at the clinic for follow-up care for pancreatitis. The patient lives alone, has high cholesterol levels, and admits to alcoholism. What is the priority intervention for this patient?

A) Provide information on alcohol cessation programs.
B) Provide teaching about dietary needs.
C) Remind the patient of the implications of recurring jaundice.
D) Provide initial instruction on medication.

Question 24

The nurse is caring for a patient who has just returned from a humanitarian trip to Central America. The patient is jaundiced and is diagnosed with hepatitis A. The patient is the parent of three school-age children. Which statement by the patient is a priority for follow-up?

A) "I need to get home to take care of my children."
B) "We cared for several very ill people on our trip."
C) "I plan to get a lot of rest in the next few days."
D) "I am likely to recover fully eventually."

Question 25

A patient with chronic pancreatitis is taking pancreatic enzymes. Which statement would indicate to the nurse that the patient correctly understands instruction about this medication?

A) "I should take this medication right before bedtime."
B) "This medication is monitored by the lab work."
C) "I take this medication only when my stomach is hurting."
D) "I will take this medication with food."

Question 26

The nurse is caring for a patient with pancreatic cancer. The nurse closely monitors for jaundice, knowing that which assessments closely correlate with jaundice? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Pruritus
B) Pain
C) Vision disturbances
D) Nausea
E) Skin lesions

Question 27

Often a patient with pancreatic cancer tends to lose weight due to the inability of the body to absorb nutrients. The nurse instructs the patient to be alert to which finding that may indicate malabsorption?

A) Vomiting
B) Jaundice
C) Steatorrhea
D) Pain

Question 28

The nurse is preparing a patient with pancreatitis for discharge to home. The nurse is instructing the patient about decreasing pancreatic stimulation to reduce pain. What method should the nurse suggest?

A) Minimize exposure to light.
B) Stay in an upright position.
C) Avoid the smell of food.
D) Increase household noise and stimulation.

Question 29

A patient is admitted with acute pancreatitis. The nurse recognizes that nutritional outcomes have been met after assessing which finding regarding the patient's weight?

A) Has increased 0.5 pounds over 1 week
B) Has increased 1 pound over the past day
C) Has decreased 2 pounds over 1 week
D) Has decreased 2 pounds over the past day

Question 30

A patient with liver cancer has been admitted to hospice. The patient asks why he developed this disease. The nurse knows there is a high likelihood this patient has which medical history?

A) Alcohol consumption
B) Frequent nausea and vomiting
C) H. pylori
D) Sexually transmitted infections

Question 31

The nurse is presenting a community education session on the prevention of liver cancer. Which information should the nurse include?

A) "The best way to prevent liver cancer is to catch it early. Liver cancer is easily detected by a physical exam."
B) "The best way to prevent liver cancer is by not drinking alcohol and avoiding high-risk behaviors that increase the chances of contracting hepatitis B and C."
C) "The best way to prevent liver cancer is to avoid public restaurants, as the cleanliness of the restaurant or the care that is taken in the food preparation cannot be predicted."
D) "The best way to prevent liver cancer is to exercise regularly."

Question 32

The nurse is teaching a patient about modifiable risk factors for cholelithiasis. Which specific factors would the nurse discuss? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Age
B) Obesity
C) Alternating rapid weight loss with rapid regaining of the weight
D) Family history
E) Elevated serum cholesterol

Question 33

The nurse is caring for a patient with hepatitis C who is treating the illness with licorice root. Which statement by the patient requires follow-up regarding this medication?

A) "I feel so tired all the time."
B) "My fingers are swollen."
C) "I have a dull ache in my abdomen."
D) "I have antibodies for hepatitis C in my blood."

Question 34

A patient in the icteric phase of hepatitis asks the nurse, "Why are my stools no longer brown?" How should the nurse respond?

A) "Your liver isn't making any of the substance that makes stools brown."
B) "The bilirubin that causes the coloration is going into your blood and turning your skin yellow."
C) "It is being released into your bloodstream and turning your blood darker red."
D) "The answer is not known. More research is needed regarding this question."

Question 35

A patient is scheduled for a laparoscopic cholecystectomy. The health care provider has indicated that there is a chance that the procedure may need to be done as an open cholecystectomy. The nurse knows that if the patient has an open procedure, what is more likely?

A) The patient may have an increase in bowel movements.
B) The patient may notice more fatty food intolerance.
C) The patient may experience faster recovery.
D) The patient may have a T-tube that will allow drainage of bile.