Deck 25: Nursing Care of Patients with Gall Bladder, Liver, & Pancreatic Disorders

Question 1

A patient who has portal system encephalopathy is receiving Neomycin (neomycin sulfate). Which of these manifestations 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

Answer 1

increased level of consciousness

Question 2

A nurse assesses a patient who has liver failure. Which of these patient findings would require immediate follow-up by the nurse?

A)asterixis
B)jaundice
C)increased abdominal girth
D)dyspnea

Answer 2

dyspnea

Question 3

A nurse is reviewing pathophysiology concepts with a group of nursing students. The nurse knows students understand the teaching that has been performed when they identify that a patient who has abdominal pain and who demonstrates a serum conjugated bilirubin level of 1.2 mg/dL most likely

A)is a newborn that needs phototherapy.
B)has a diagnosis that causes large amounts of red blood cell death.
C)has a disorder of the biliary system.
D)has a small bowel obstruction.

Answer 3

has a disorder of the biliary system.

Question 4

Which of these teaching points would be appropriate for a nurse to include when teaching a patient who has undergone a liver transplant?

A)Eat a high-protein diet.
B)Reduce scheduled tacrolimus to every other day if nausea occurs.
C)Take acetaminophen (Tylenol) if fever develops.
D)Report sore throats to your healthcare provider.

Question 5

Which of these outcomes 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 6

When assessing a patient who has cholilithiasis, which of these patient statements indicates a progression to cholecystitis? Select all that apply.

A)"I've been in terrible pain for two hours."
B)"I'm hot and sweating, 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 7

A nurse is teaching a patient about strategies for reducing the risk of hepatitis B transmission. Which of these statements, if made by the patient, indicate understanding of teaching? 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 8

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

A)low residue; no alcohol
B)low fat; no alcohol
C)low fat; no fiber
D)mechanical soft

Question 9

The nurse has given a patient instruction about the possible complications of unresolved cholecystitis. Which of these statements, if made by the patient, would indicate that the patient has the correct understanding of the instructions? Select all that apply.

A)"I could have infected pus stored in my gallbladder."
B)"My bladder could rot and cause a big infection in my abdomen."
C)"A hole could form a connection between my gallbladder and intestines."'
D)"My intestines could be blocked with a gallstone."
E)"My gallbladder could turn inside out into the bile duct."

Question 10

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

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

Question 11

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

A)jaundice
B)flu-like syndrome
C)gallbladder pain
D)clay-colored stools

Question 12

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

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

Question 13

The patient with pancreatitis asks the nurse, "Why are my stools so frothy and smell so bad?" The nurse's best response is which of the following?

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."

Question 14

A nurse is caring for a patient with cholilithiasis who has a new laboratory finding of serum amylase of 300 units/L. The patient states, "My primary healthcare 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 15

When assessing a patient who is experiencing hepatocellular failure, which of these findings would best indicate the patient is developing ascites?

A)accumulation of fluid in the abdomen
B)jaundiced skin
C)ecchymosis
D)upper-right quadrant pain

Question 16

The nurse is caring for a patient whose diagnostic exams reveal that the patient has liver tissue fibrosis, decreased liver mass, impaired liver function, and impaired blood flow to the liver. The nurse notes new ecchymotic areas on the patient's arms and legs. Which of the following laboratory findings will the nurse analyze regarding this finding? Select all that apply. Select all that apply.

A)complete blood count
B)coagulation studies
C)serum albumin
D)serum ammonia levels
E)serum hepatitis antibodies

Question 17

A patient who reports a severe, steady pain in the epigastric area and nausea and vomiting states, "This happens every time I eat barbequed ribs." The nurse considers the most likely cause of the symptoms to be which of the following?

A)porcine intolerance
B)obesity
C)cholelithiasis
D)pancreatitis

Question 18

The nurse should instruct the patient who is at risk for cholelithiasis to make which lifestyle modification?

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

Question 19

Which of these findings, if identified 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 heal

Question 20

A nurse is caring for a patient with a liver abscess who is experiencing nausea and vomiting. Which of these nursing diagnoses should receive priority for this patient?

A)Fluid Volume Excess
B)Fluid Volume Deficit
C)Alteration in Breathing Patterns
D)Disturbed Body Image

Question 21

The nurse is teaching a patient about the effects of liver failure. The nurse knows the patient understands teaching when the patient identifies which of the following as effects of liver failure? Select all that apply. Select all that apply.

A)"My abdomen is becoming very large."
B)"My blood sugar is sometimes too high and sometimes too low."
C)"My left lower leg is red and swollen."
D)"My menstrual cycle has become very irregular."
E)"My skin appears yellow."

Question 22

A nurse should include which of these teaching points when planning discharge for a patient who has a T-tube following a cholecystectomy? Select all that apply.

A)Position the collecting device upright and above the surgical wound.
B)Report drainage of more than 500 mL per day to healthcare provider.
C)Primarily maintain a side-lying position to facilitate drainage.
D)Report skin redness or irritation in the drain site area.
E)Pin drainage tube to clothing to maintain slight traction on site.

Question 23

The nurse is teaching a patient with an acute attack of cholecystitis about nutritional interventions. Which of these statements, if made by the patient would indicate that the patient needs further instruction?

A)"I need to stop eating and drinking everything for a while."
B)"I may need a tube inserted into my nose that goes all of the way into my stomach."
C)"I may be prescribed vitamins B and C."
D)"I may need extra bile salts to promote health."

Question 24

A patient with cholithiasis had an extracorporeal shock wave lithotripsy. Which of the following statements, if made by the patient would indicate that the patient remembered the procedure accurately? Select all that apply.

A)"It didn't take long, just a few hours."
B)"They gave me some medication in my IV.I didn't feel much."
C)"The nurses kept asking me if my abdomen hurts or if I was nauseated."
D)"I was glad I could move around a lot during the procedure."
E)"They used a big machine to guide the shock waves to the stones."

Question 25

The nurse assesses the nutritional status of a patient who has cholelithiasis and a body mass index of 3

A)Ask the patient to discuss the patient's typical daily menu choices.
B)Ask the patient to discuss strategies the patient uses to manage their weight.
C)Ask the patient if he or she takes daily supplemental vitamin C.
D)Ask the patient if he or she has been skipping meals to decrease gallbladder pain.
E)Which of the following actions should the nurse take initially?

Question 26

The nurse is caring for a hospitalized patient with an acutely inflamed gallbladder who states, "Suddenly, the pain is just gone. Can I go home?" What is the nurse's best response?

A)"It is your choice.You are feeling better and not required to stay."
B)"Please stay until your healthcare provider sees you tomorrow."
C)"I will inform your healthcare provider of the change in your symptoms."
D)"Yes, as soon as we perform the prescribed ultrasound of the gallbladder."

Question 27

The nurse is observing a nursing student who is caring for a patient with liver failure and jaundice. The student asks the patient each of the following questions. Which question is helpful in determining if the cause of the jaundice is hemolytic?

A)"Do you have sickle cell anemia?"
B)"What color is your urine?"
C)"What color are your stools?"
D)"Do you have any gallbladder problems?"

Question 28

The patient in the icteric phase of hepatitis asks the nurse, "Why are my stools no longer brown?" The nurse most correctly answers with which of the following?

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

Question 29

The home care patient who is scheduled for a laparoscopic cholecystectomy in four days asks a nurse, "How can I best promote comfort?" Which of these responses would be most appropriate for the nurse to make?

A)"You will feel better if you sit in a recliner and drink water and try not to eat anything.Do not eat any fat."
B)"You will feel better if rest in bed and do not eat anything until the procedure.Drink only water and milk."
C)"You will feel better if alternate lying on your back, then your abdomen.You may eat anything, except fatty food."
D)"You will feel better if walk as frequently as possible.You may drink coffee, but not soda."

Question 30

A nurse assesses a patient who is taking chenodiol (Chenix). Which of the following patient statements indicates that immediate follow-up by the nurse is required? Select all that apply.

A)"I could see the big gallstone on the x-ray, but this medication doesn't seem to be helping at all.I don't feel better after taking it for four months."
B)"My rectal area is tender from all of the diarrhea I've been experiencing."
C)"My skin looks yellow."
D)"I can't afford my medication and have been cutting pills in half to make it last longer."
E)"I can see bits of gallstones in my stools."

Question 31

A nurse should instruct a patient who wishes to reduce the incidence of gallstone and cholecystitis to do which of the following? Select all that apply. Select all that apply.

A)Walk for 30 minutes five times a week.
B)Eat a low-fiber, high-carbohydrate diet.
C)Eat unsaturated, rather than saturated fats.
D)Eat a low-carbohydrate diet.
E)Lose weight by any means possible.

Question 32

The patient with acute cholecystitis has an oral temperature of 101.8° F. The patient tells the nurse, "I must have the flu." The nurse's best response is which of the following?

A)"Your cholecystectomy cannot be performed laparoscopically now."
B)"Tell me exactly what you ate for your last meal."
C)"Bacterial infection is often present in cholelithiasis."
D)"I will call the surgeon and ask to postpone the cholecystectomy."

Question 33

A patient has been given instructions about a laparoscopic cholecystectomy. Which of these statements, if made by the patient, would indicate further teaching is needed?

A)"I should be able to go home the day after the procedure."
B)"I will probably have bandages over the puncture sites."
C)"I am glad I won't need to have an open cholecystectomy."
D)"I will tell the nurse if I feel nauseated after surgery."

Question 34

The patient with acute cholithiasis has an order for an NG tube insertion. The patient asks, "Why do I need to have a tube placed from my nose to my stomach?" The nurse's best answer is which of the following?

A)"Because you have not been able to follow your prescribed diet and exercise plan."
B)"Because we need to suck the bile out through your nose as it isn't going to your duodenum."
C)"Because keeping your stomach empty allows your gallbladder to rest, reducing pain."
D)"Because placing the NG early in the cholithiasis attack will prevent pancreatitis."

Question 35

The nurse is caring for a patient who has liver failure and is taking lactulose (Chronulac). Which of these laboratory data would indicate that the medication is having the desired effect?

A)increased serum ammonia level
B)decreased serum ammonia level
C)increased serum ALT level
D)decreased serum ALT level

Question 36

The nurse is teaching a patient about modifiable risk factors for cholelithiasis. Which of these statements, if made by the patient would indicate the patient has the correct understanding of modifiable risk factors? Select all that apply.

A)age
B)obesity
C)alternating weight loss and gain
D)family history
E)elevated serum cholesterol

Question 37

A patient scheduled for a laparoscopic cholecystectomy asks the nurse why a surgical consent for a laparotomy must also be completed. The nurse's best answer is which of the following?

A)"By signing both now, you'll never have to sign another one.We'll keep the extra on file for the future."
B)"Surgeons base their decision on whether to do the procedure laparoscopically or with a full incision on many factors.With this signed, the surgeon has options."
C)"You will be ready if the laparoscopic operating rooms are busy today."
D)"The surgeon will start the procedure laproscopically but may need to make an incision in some cases in order to complete the procedure."

Question 38

Which of these questions would be most important for a nurse to ask when assessing a patient who is taking the herb goldenseal for cholecystitis?

A)"Do you know there are highly effective prescription medications for cholecystitis?"
B)"Are you pregnant or planning to become pregnant soon?"
C)"How did you first become aware of the use of goldenseal for cholecystitis?"
D)"Have you considered using a peppermint and goldenseal extract mixture?"

Question 39

Which of these factors in a patient's history are likely related to liver failure? Select all that apply.

A)The patient had two epidsodes of epistaxis.
B)The patient had toxic levels of a prescribed medication.
C)The patient is oriented to person and place but not to time.
D)The patient decreased urinary output.
E)The patient has cholithiasis.

Question 40

The nurse is teaching a patient who has portal hypertension. The nurse knows teaching has been effective when the patient states, "Portal hypertension means

A)blood backs up in the liver.It causes enlarged blood vessels in my esophagus."
B)blood leaks from my liver.It causes me to feel hungry frequently."
C)fast spreading' high blood pressure.It causes red veins on my arms."
D)high blood pressure throughout the abdomen.It causes me to feel confused."

Question 41

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

A)Patient states, "I feel so tired all of the time."
B)Patient states, "My fingers feel numb and tingly."
C)Patient states, "I have a dull ache in my abdomen."
D)Patient states, "I have antibodies for hepatitis C in my blood."

Question 42

The nurse is caring for a patient with a new diagnosis of hepatitis that was found when the patient was having a preoperative assessment for a routine colonoscopy. The patient states, "I don't feel ill, but my healthcare provider tells me I am infectious and can spread this illness to others." The patient has a distant history of injection drug use. Based on this information, the nurse seeks information regarding the most likely cause of the patient's hepatitis which is which of the following?

A)hepatitis A
B)hepatitis B
C)hepatitis C
D)hepatitis D

Question 43

The nurse is caring for a patient who returned from a humanitarian trip to Central American two weeks ago. The patient is jaundiced and is diagnosed with hepatitis A. The patient is the parent of three school-age children. Which statement, if made by the patient, is a priority for follow-up?

A)"I can't go home and expose my children to this."
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."