Deck 31: Care of Patients With Disorders of the Gallbladder,liver,and Pancreas

Question 1

The nurse is caring for a patient diagnosed with gallstones.The patient's medical record indicates the presence of two gallstones less than 1.5 inches.The patient is obese and has a history of insulin-dependent diabetes.The patient asks the nurse why he could not have a lithotripsy.The nurse points out that the criteria for the procedure are rigid and that he failed to meet them because:

A)he has only two gallstones.
B)the gallstones are all less than 1.5 inches.
C)he is obese.
D)he is diabetic.

Answer 1

he is obese.

Question 2

The nurse caring for a patient with acute pancreatitis assesses a bluish tinge around the patient's umbilicus.This finding is best reported as:

A)effect of increased amylase.
B)indication of retroperitoneal hemorrhage.
C)inflammatory response to a possible pseudocyst.
D)abdominal distention related to ascites.

Answer 2

indication of retroperitoneal hemorrhage.

Question 3

The nurse explains that the jaundice observed in a person with hepatitis is related to the:

A)ischemia of the liver.
B)increased bile production by the enlarged Kupffer cells.
C)destruction of RBCs by the hepatitis virus.
D)congestion in the liver obstructing bile flow.

Answer 3

congestion in the liver obstructing bile flow.

Question 4

In a patient who had a cholecystectomy 3 days ago,the nurse assesses that the bile is no longer obstructed from entering the bowel by the appearance of:

A)excessive flatus.
B)dark brown stool.
C)dark urine.
D)increased appetite.

Question 5

The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of a(n):

A)liver biopsy.
B)elevated aspartate aminotransferase (AST).
C)elevated alanine aminotransferase (ALT).
D)elevated lactate dehydrogenase (LDH).

Question 6

A patient who has had his fifth attack of gallstones is encouraged to have a cholecystectomy to prevent the threat of:

A)further attacks.
B)nutritional compromise.
C)cancer of the gallbladder.
D)hepatitis.

Question 7

A patient who had a laparoscopic cholecystectomy 4 hours ago complains of fullness in the abdomen and mild discomfort.Because his vital signs are stable,the nurse should:

A)ambulate the patient to reduce gas.
B)notify the charge nurse of possible hemorrhage.
C)position the patient in high Fowler's.
D)give the ordered PRN analgesic.

Question 8

In caring for a patient with hepatitis B,the nurse would follow:

A)Standard Precautions.
B)strict isolation.
C)Contact Precautions.
D)surgical asepsis.

Question 9

A patient with cirrhosis complains of the blandness of the low-protein diet and questions its effectiveness.The nurse reminds the patient that the low-protein diet helps his condition by:

A)decreasing the production of ammonia.
B)decreasing the production of urea.
C)supporting the manufacture of clotting factors.
D)decreasing the production of albumin.

Question 10

The physician has prescribed neomycin enemas for a patient with cirrhosis.The patient questions why they are being used.Which response by the nurse is most appropriate?

A)These enemas help prevent infection.
B)These enemas help reduce straining during a bowel movement.
C)These enemas kill intestinal flora.
D)These enemas aid in reducing ascites.

Question 11

A patient with esophageal varices is receiving potent vasoconstrictors to help prevent hemorrhage.The nurse will be concerned if the patient complains of pain in the:

A)chest.
B)flank area.
C)lower legs.
D)back.

Question 12

The nurse is caring for a patient diagnosed with hepatitis during the posticteric phase of the condition.When planning care,which intervention should be of the highest priority?

A)Encouraging frequent rest periods
B)Monitoring intake and output
C)Taking a daily weight
D)Encouraging compliance with a low-sodium diet

Question 13

The nurse explains to a patient with cholelithiasis that the purpose of the cholescintigraphy (HIDA scan)is to:

A)visualize the location of the gallstones.
B)assess the amount of inflammatory swelling.
C)diagnose abnormal contraction of the gallbladder.
D)assess composition of the gallstones.

Question 14

A patient comes to the emergency department with the complaint of severe vomiting and nausea and a temperature elevation to 101° F.The patient complains of stomach pain that radiates to his right scapula.These assessments suggest:

A)cholecystitis.
B)hepatitis.
C)pancreatitis.
D)gastroenteritis.

Question 15

The nurse is speaking with a patient who has concerns about the development of cholelithiasis.The nurse correctly includes which risk factors for the condition? (Select all that apply.)

A)Obesity
B)Daily exercise regimen
C)Diabetes mellitus
D)Taking cholesterol-lowering drugs
E)Mexican American ethnicity

Question 16

A patient has reported to the clinic with concerns about contracting hepatitis A from her boyfriend.What response by the nurse is most appropriate?

A)"If you are having unprotected sexual intercourse with your partner, there is a relatively high risk for hepatitis A."
B)"Hepatitis A is not transmitted as a result of close contact with an infected individual."
C)"Hepatitis A transmission is associated with contact with infected body fluids."
D)"Hepatitis A is relatively uncommon in our country and seen more in underdeveloped countries."

Question 17

The nurse assesses that a patient with cirrhosis is deteriorating when there is evidence of:

A)an increase in urine output related to the effect of the diuretics.
B)a decrease in total bilirubin.
C)confusion related to rising ammonia levels.
D)a decrease in jaundice.

Question 18

A 20-year-old college student who has not been immunized against hepatitis B virus (HBV)comes to the clinic and reports that he has been exposed to hepatitis B.The nurse recommends that he get immediate protection by acquiring:

A)a prescription for a broad-spectrum antibiotic.
B)a prescription for an antiviral agent.
C)the first of the three immunizations for HBV.
D)an injection of hepatitis B immune globulin (HBIG).

Question 19

The nurse is caring for a patient being treated for recurrent gallstones.The patient questions the need to have the stones removed,voicing a concern about the condition causing cancer.What statement by the nurse is most correct?

A)"The presence of gallstones is not linked to the development of cancer."
B)"Only those patients with gallstones having multiple health concerns are at risk for the development of cancer."
C)"Gallstones cause an irritation which is linked to an increase in the incidence of cancer."
D)"The pathological analysis of gallstones will tell if they are the type linked to cancer."

Question 20

The nurse reading the laboratory reports for a patient with acute hepatitis is aware that an indicator supporting this diagnosis is:

A)elevated aspartate aminotransferase (AST).
B)decreased alanine aminotransferase (ALT).
C)decreased g-glutamyl transpeptidase (GGT).
D)increased prothrombin time.

Question 21

The nurse reinforces that the immunization for HBV is believed to provide _____ immunity.

Question 22

The nurse plans for the skin care of the patient with ascites,which would include: (Select all that apply.)

A)bathing in tepid water.
B)applying emollients to decrease itching.
C)cutting the patient's fingernails short.
D)changing the patient's position every 1 to 2 hours.
E)coaching in deep-breathing exercises.

Question 23

The nurse explains that bile salts deposited in the skin cause jaundice and also cause _____.

Question 24

The nurse is discussing the impact of cirrhosis on liver function with the family of a dying patient.The nurse explains that,when the damage caused by cirrhosis blocks the blood flow through the liver,the result is: (Select all that apply.)

A)portal hypertension.
B)decrease in metabolic processes of the liver.
C)decrease in clotting factors.
D)increase in ascites.
E)decrease in aldosterone.

Question 25

Matching
Match the hepatitis virus (HV) with the characteristics that best describe it.

Most likely to lead to cirrhosis

A)HAV
B)HBV
C)HCV
D)HDV
E)HEV

Question 26

The nurse caring for a patient with acute pancreatitis will include in the daily assessments: (Select all that apply.)

A)auscultation of bowel sounds to detect paralytic ileum.
B)amount of food eaten each meal.
C)abdominal girth to detect ascites.
D)effectiveness of pain control.
E)urine output.

Question 27

Matching
Match the hepatitis virus (HV) with the characteristics that best describe it.

Prevalent in less developed countries

A)HAV
B)HBV
C)HCV
D)HDV
E)HEV

Question 28

Matching
Match the hepatitis virus (HV) with the characteristics that best describe it.

Fecal-oral transmission,acute onset

A)HAV
B)HBV
C)HCV
D)HDV
E)HEV

Question 29

The nurse points out to a patient recently diagnosed with hepatitis B virus (HBV)that the virus is found not only in blood but also in: (Select all that apply.)

A)semen.
B)vaginal secretions.
C)sweat.
D)breast milk.
E)human feces.

Question 30

A patient with advanced cirrhosis develops esophageal varices as a direct result of portal hypertension.The nurse anticipates that this complication will be addressed by: (Select all that apply.)

A)insertion of a Blakemore-Sengstaken tube.
B)administration of IV vasopressin (Pitressin).
C)administration of vitamin B.
D)lactulose to empty swallowed blood in colon.
E)vasoconstrictors to reduced portal blood flow.

Question 31

Matching
Match the hepatitis virus (HV) with the characteristics that best describe it.

Coexists with HBV

A)HAV
B)HBV
C)HCV
D)HDV
E)HEV

Question 32

Matching
Match the hepatitis virus (HV) with the characteristics that best describe it.

Transmission by contact with blood and body fluids,perinatal transmission from mother to infant

A)HAV
B)HBV
C)HCV
D)HDV
E)HEV