Deck 25: Nursing Care of Patients With Gallbladder, Liver, and Pancreatic Disorders

Question 1

The nurse is assessing a patient with cholelithiasis. Which statements by the patient indicate a progression to cholecystitis?

A) "I've been in terrible pain for 2 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."

Answer 1

"I'm hot and sweating, then cold and shivering."
"I need an emesis basin; I've vomited four times."
"My abdomen and my back both hurt."

Question 2

A patient with hepatitis is receiving interferon alpha. Which manifestation indicates that the patient is experiencing an untoward effect of this medication?

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

Answer 2

flulike syndrome

Question 3

The nurse is caring for a patient with a Sengstaken-Blakemore tube. Which assessment finding should the nurse immediately report 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 3

decreased level of consciousness

Question 4

A patient with pancreatitis asks the nurse, "Why are my stools so frothy and smell so bad?" How should the nurse respond?

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 5

The nurse is caring for a patient with chronic pancreatitis and a serum amylase level of 180 units/L. Which dietary plan should the nurse instruct the patient to follow?

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

Question 6

The nurse is teaching a patient about strategies for reducing the risk of hepatitis B transmission. Which statements by the patient indicate teaching has been effective?

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 7

The nurse has instructed a patient about the possible complications of unresolved cholecystitis. Which patient statements indicate that teaching has been effective?

A) "I could have infected pus stored in my gallbladder."
B) "My gallbladder 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 8

The nurse is planning care for a patient scheduled for paracentesis to treat ascites. Which outcome should the nurse use for this patient's plan of care?

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 9

The nurse is assessing a patient who is experiencing hepatocellular failure. Which finding best indicates that the patient is developing ascites?

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

Question 10

The nurse is instructing a patient recovering from a liver transplant. What should the nurse include in this teaching?

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

Question 11

A patient who reports a severe, steady pain in the epigastric area, nausea, and vomiting states, "This happens every time I eat barbecued ribs." What should the nurse consider as the most likely cause of the patient's symptoms?

A) intolerance to pork
B) obesity
C) cholelithiasis
D) pancreatitis

Question 12

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

A) increase in potassium level
B) asterixis
C) relief of jaundice
D) increased level of consciousness

Question 13

The nurse is reviewing pathophysiology concepts to understand what is occurring with an adult patient who has abdominal pain and a serum conjugated bilirubin level of 1.2 mg/dL. What should the nurse suspect is occurring with this patient?

A) a disease that requires phototherapy
B) a disorder that causes large amounts of red blood cell death
C) a disorder of the biliary system
D) a small bowel obstruction

Question 14

A patient with epigastric pain has a serum amylase level of 369 units/L. What should the nurse do?

A) continue to monitor the patient
B) refer the patient to a dietician
C) contact the primary healthcare provider
D) question the patient regarding alcohol use patterns

Question 15

The nurse is preparing instructions for a patient who is at risk for cholelithiasis. What lifestyle modification should the nurse include in this teaching?

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

Question 16

A patient with cholelithiasis has a serum amylase level of 300 units/L. What should the nurse consider as 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 17

The nurse is assessing a patient with ascites caused by liver failure. Which finding would require immediate follow-up by the nurse?

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

Question 18

A patient with a liver abscess is experiencing nausea and vomiting. Which problem should the nurse identify as a priority for this patient?

A) too much fluid
B) not enough fluid
C) problem breathing
D) altered self-image

Question 19

The nurse notes new areas of ecchymosis on the arms and legs of a patient with liver cirrhosis. Which laboratory test results should the nurse monitor because of this finding?

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

Question 20

A patient with cirrhosis is experiencing hypertension, edema, and shortness of breath. What should the nurse identify as the patient's priority problem?

A) insufficient fluid level
B) problem with tissue perfusion
C) too much bodily fluid
D) problem with integumentary status

Question 21

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

A) ask the patient to discuss typical daily menu choices
B) ask the patient to discuss strategies used to manage weight
C) ask if the patient takes daily supplemental vitamin C
D) ask if the patient has been skipping meals to reduce gallbladder pain
E) What action should the nurse take initially?

Question 22

The nurse is teaching a patient about modifiable risk factors for cholelithiasis. What risk factors will the nurse discuss?

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

Question 23

A patient with acute cholecystitis is concerned about having the flu because of an oral temperature of 101.8°F. What should the nurse respond to the patient?

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 24

A patient has been given instructions about a laparoscopic cholecystectomy. Which patient statement indicates further teaching is needed?

A) "I should be able to go home within a 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 25

A patient scheduled for a laparoscopic cholecystectomy in 4 days asks how pain can be controlled until the surgery. How should the nurse respond?

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

Question 26

A patient wants to reduce the risk of developing gallstones and cholecystitis. What should the nurse instruct this patient?

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 27

A patient is notified of a diagnosis of hepatitis by the healthcare provider and informed that it can be transmitted to others even though the patient has not been ill. The patient has a distant history of injection substance use. For which type of hepatitis should the nurse plan care for this patient?

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

Question 28

The nurse is assessing a patient with liver cirrhosis. Which findings should the nurse relate to the patient's failed liver function?

A) The patient had two episodes 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's urinary output has decreased.
E) The patient has cholelithiasis.

Question 29

The nurse is caring for a patient taking chenodiol (Chenix). Which patient statements indicate the need for immediate follow-up by the nurse?

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 4 months."
B) "My rectal area is tender from all the diarrhea I've been having."
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 30

A patient with liver failure is taking lactulose (Chronulac). Which laboratory data indicates 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 31

The nurse is teaching a patient with an acute attack of cholecystitis about nutritional interventions. Which patient statement indicates additional teaching is required?

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 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 32

The nurse, teaching a patient about portal hypertension, knows teaching has been effective when the patient makes which statement?

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

Question 33

The 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 pigment is backing up 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 34

A patient scheduled for a laparoscopic cholecystectomy asks the nurse why a surgical consent for a laparotomy must also be completed. How should the nurse respond?

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 to complete the procedure."

Question 35

A patient who returned from a humanitarian trip to Central America 2 weeks ago is jaundiced and diagnosed with hepatitis A. The patient is the parent of three school-age children. Which patient statement should the nurse follow up with the patient?

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."

Question 36

A patient with cholelithiasis is recovering from extracorporeal shock wave lithotripsy. Which statements indicate that the patient remembers the procedure accurately?

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) "Afterwards the nurses kept asking me if my abdomen hurt 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 37

A patient with an acutely inflamed gallbladder states that the pain has suddenly stopped. The patient wants to 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 38

The nurse is assessing a patient with liver failure and jaundice. Which question should the nurse ask to determine if the cause of the jaundice is hemolytic?

A) "Have you been diagnosed with a disorder of red blood cell destruction?"
B) "What color is your urine?"
C) "What color are your stools?"
D) "Do you have any gallbladder problems?"

Question 39

The nurse is teaching a patient about the effects of liver failure. The nurse knows the patient understands when the patient identifies which manifestations as related to liver failure?

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 40

The patient with acute cholelithiasis asks why a nasogastric tube has to be inserted. What is the nurse's best response?

A) "You have not been able to follow your prescribed diet and exercise plan."
B) "We need to suck the bile out through your nose as it isn't going to your duodenum."
C) "Keeping your stomach empty allows your gallbladder to rest, reducing pain."
D) "The tube will prevent pancreatitis."

Question 41

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 feel numb and tingly."
C) "I have a dull ache in my abdomen."
D) "I have antibodies for hepatitis C in my blood."

Question 42

Type: MCMA A patient recovering from Whipple's procedure is being transferred to the medical-surgical care area. On which interventions should the nurse focus to determine if the patient is developing a complication from the surgery?

A) assessing heart rate every 2 hours
B) monitoring urine output ever hour
C) turning and repositioning every 2 hours
D) measuring blood pressure every 2 hours
E) assisting to a standing position every 4 hours

Question 43

The nurse is concerned that a patient with injuries from a motor vehicle crash is experiencing bleeding from liver trauma. What did the nurse assess to make this clinical determination?

A) new onset of pruritus
B) new onset of lightheadedness
C) heart rate 112 beats per minute
D) requesting more water to drink
E) respiratory rate 26 breaths per minute

Question 44

A patient with chronic pancreatitis is prescribed pancrelipase (Lipancreatin). What should the nurse instruct the patient about this medication?

A) Take the medication with meals or snacks.
B) Take the medication with milk or ice cream.
C) Stop taking the medication if bowel movements increase.
D) Do not crush enteric coated doses of the medication.
E) Take this medication until advised otherwise by the healthcare provider.