AH 2 Test 3

A patient is admitted with an abrupt onset of jaundice, nausea and vomiting, hepatomegaly, and abnormal liver function studies. Serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate? a. "Have you been around anyone with jaundice?" b. "Do you use any prescription or over-the-counter (OTC) drugs?" c. "Are you taking corticosteroids for any reason?" d. "Is there any history of IV drug use?"

b. "Do you use any prescription or over-the-counter (OTC) drugs?" The patient's symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms suggest toxic hepatitis, which can be caused by commonly used OTC drugs such as acetaminophen (Tylenol). Exposure to a jaundiced individual and a history of IV drug use are risk factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed.

A nurse is providing discharge for a client who has chronic Hep C. Which of the following statements by the client indicates an understanding of the teaching? a. "I will avoid alcohol until I'm no longer contagious." b. "I will avoid medications containing acetaminophen." c. "I will decrease my intake of calories." d. "I will need treatment for 3 months."

b. "I will avoid medications containing acetaminophen." A client who has hepatitis C should avoid medications containing acetaminophen, which can cause additional liver damage. This client carries the risk of transmission to others through blood-to-blood contact and should avoid all alcohol consumption due to the increased risk of cirrhosis. This client should eat small, frequent meals that are high in carbohydrates and calories. This client will need treatment for at least 6 months.

A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse is the best indicator that these therapies have been effective? a. Bowel sounds are present. b. Abdominal pain is decreased. c. Electrolyte levels are normal. d. Grey Turner sign resolves.

b. Abdominal pain is decreased. NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status have been effective. Electrolyte levels will be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this occur to determine whether treatment was effective.

A nurse assessing a patient with pancreatitis suspects the presence of Grey Turner sign when the patient exhibits: a. Jaundice of the sclera b. Bluish discoloration of the flank area c. Bluish discoloration of the periumbilical area d. Left abdominal pain that occurs with movement

b. Bluish discoloration of the flank area The Grey Turner sign includes a bluish discoloration, or ecchymosis, on the left or right flank area, the result of internal bleeding caused by pancreatitis. Jaundice of the sclera is associated with liver disorders and with increased serum bilirubin. Bluish discoloration of the periumbilical area is also seen in bleeding associated with pancreatitis and is known as the Cullen sign. Left abdominal pain that occurs with movement may be seen with pancreatitis but is not associated with the Grey Turner sign.

A nurse is reviewing the laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? a. blood glucose 110 mg/dL b. Increased serum amylase c. WBC 9,000/mm3 d. Decreased bilirubin

b. Increased serum amylase Serum amylase levels are increased in a client who has acute pancreatitis because of the pancreatic cell injury. A blood glucose of 110 mg/dL and a WBC of 9,000/mm3 are within the expected reference ranges. Elevated serum glucose and WBC counts are expected findings for a client who has acute pancreatitis. Increased bilirubin levels are an expected finding in a client who has acute pancreatitis due to the hepatobiliary obstructive process.

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention should the nurse expect to include in the patient's plan of care? a. Immediately start enteral feeding to prevent malnutrition b. Insert a nasogastric (NG) tube and maintain nothing by mouth (NPO) status to allow the pancreas to rest c. Initiate early prophylactic antibiotic therapy to prevent infection d. Administer acetaminophen (Tylenol) every four hours for pain relief

b. Insert a nasogastric (NG) tube and maintain nothing by mouth (NPO) status to allow the pancreas to rest Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. Enteral feedings will be used only for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is needed only with acute necrotizing pancreatitis and signs of infection. The pain will be treated with IV morphine because of the NPO status. Test-Taking Tip: Start with answering all the questions that you feel confident in answering. If you cannot immediately think of the answer to a question, give it a few seconds of thought. If the answer comes to you, mark it and move on. If not, skip it, circle the number so you know to come back to it, and go to the next question.

A physician orders spironolactone, 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? a. Serum potassium level of 3.5 mEq/L b. Loss of 2.2 lb (1 kg) in 24 hours c. Blood pH of 7.25 d. Serum sodium level of 135 mEq/L

b. Loss of 2.2 lb (1 kg) in 24 hours Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. Decrease glucose production b. Stimulate glucose output by the liver c. Increase glucose transport into the cells d. Independently regulate glucose level in the blood

b. Stimulate glucose output by the liver The counter regulatory hormones have the opposite effect of insulin by stimulating glucose production and output by the liver and by decreasing glucose transport into the cells. The counter regulatory hormones and insulin together regulate the blood glucose level.

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 inhibit the development of gastric ulcers. b. The medication will prevent irritation to the esophageal varices. c. The medication will decrease nausea and anorexia. d. The medication will reduce the risk for aspiration.

b. The medication will prevent irritation to the esophageal varices. The therapeutic action of H2 receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acid gastric contents. Although ranitidine does decrease the risk for peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, these are not the primary purpose for H2 receptor blockade in this patient.

A 32-year-old patient has early alcoholic cirrhosis diagnosed by a liver biopsy. When planning patient teaching, the priority information for the nurse to include is the need for a. vitamin B supplements. b. abstinence from alcohol. c. maintenance of a nutritious diet. d. long-term, low-dose corticosteroids.

b. abstinence from alcohol. The disease progression can be stopped or reversed by alcohol abstinence. The other interventions may be used when cirrhosis becomes more severe to decrease symptoms or complications, but the priority for this patient is to stop the progression of the disease.

A patient with cirrhosis has 4+ pitting edema of the feet and legs and massive ascites. The data indicate that it is most important for the nurse to monitor the patient's a. temperature. b. albumin level. c. hemoglobin. d. activity level.

b. albumin level. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of ascites and edema. The other parameters should also be monitored, but they are not contributing factors to the patient's current symptoms.

The nurse identifies a nursing diagnosis of risk for impaired skin integrity for a patient with cirrhosis who has ascites and 4+ pitting edema of the feet and legs. An appropriate nursing intervention for this problem is to a. restrict dietary protein intake. b. arrange for a pressure-relieving mattress. c. perform passive range of motion QID. d. turn the patient every 4 hours.

b. arrange for a pressure-relieving mattress. The pressure-relieving mattress will decrease the risk for skin breakdown for this patient. Dietary protein intake may be increased in patients with ascites to improve oncotic pressure. Turning the patient every 4 hours will not be adequate to maintain skin integrity. Passive range of motion will not take pressure off areas like the sacrum that are vulnerable to breakdown.

A nurse is providing teaching for a client who has cirrhosis and a new prescription of lactulose. The nurse should include which of the following instructions in the teaching? a. notify the provider if bloating occurs b. expect to have 2 to 3 soft stools per day c. restrict carbohydrates in the diet d. limit oral fluid intake to 1,000 mL per day of clear liquids

b. expect to have 2 to 3 soft stools per day The purpose of administering lactulose is to promote the excretion of ammonia in the stool. The nurse should instruct the client to expect more frequent stools to achieve this outcome. Bloating is an expected adverse effect of lactulose and it is not necessary to notify the provider. The nurse should instruct the client to follow a high-carbohydrate diet that includes simple carbohydrates. Dehydration can result from increased stool frequency and the nurse should instruct the client to drink 1,500 to 2,000 mL per day.

A patient with cirrhosis has a massive hemorrhage from esophageal varices. In planning care for the patient, the nurse gives the highest priority to the goal of a. controlling bleeding. b. maintenance of the airway. c. maintenance of fluid volume. d. relieving the patient's anxiety.

b. maintenance of the airway. Maintaining gas exchange has the highest priority because oxygenation is essential for life. The airway is compromised by the bleeding in the esophagus and aspiration easily occurs. The other goals would also be important for this patient, but they are not as high a priority as airway maintenance.

Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply) a. restricting protein intake. b. monitoring blood glucose levels. c. observing for signs of hypotension. d. administering medication in equal doses. e. protecting patient from exposure to infection.

b. monitoring blood glucose levels. e. protecting patient from exposure to infection. Hyperglycemia occurs with Cushing disease because of glucose intolerance (associated with cortisol-induced insulin resistance) and increased gluconeogenesis by the liver. High levels of corticosteroids increase susceptibility to infection and delay wound healing.

A patient who is hospitalized with abdominal pain and watery, incontinent diarrhea is diagnosed with Clostridium difficile. In planning care for the patient, the nurse will a. order a diet with no dairy products for the patient. b. place the patient in a private room with contact isolation. c. explain to the patient why antibiotics are not being used. d. teach the patient about proper food handling and storage.

b. place the patient in a private room with contact isolation. Because C. difficile is highly contagious, the patient should be placed in a private room and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile. Improper food handling and storage do not cause C. difficile.

The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that a. a lack of clotting factors promotes the collection of blood in the abdominal cavity. b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space. c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel. d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.

b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space. Ascites is the accumulation of serous fluid in the peritoneal or abdominal cavity and is a common manifestation of cirrhosis. With portal hypertension, proteins shift from the blood vessels through the larger pores of the sinusoids (capillaries) into the lymph space. When the lymphatic system is unable to carry off the excess proteins and water, those substances leak through the liver capsule into the peritoneal cavity. Osmotic pressure of the proteins pulls additional fluid into the peritoneal cavity. A second mechanism of ascites formation is hypoalbuminemia, which results from the inability of the liver to synthesize albumin. Hypoalbuminemia results in decreased colloidal oncotic pressure. A third mechanism is hyperaldosteronism, which occurs when aldosterone is not metabolized by damaged hepatocytes. The increased level of aldosterone causes increases in sodium reabsorption by the renal tubules. Sodium retention and an increase in antidiuretic hormone levels cause additional water retention.

A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include a. having genetic testing done. b. recommending a heart-healthy diet. c. the necessity to reduce weight rapidly. d. avoiding alcohol until liver enzymes return to normal.

b. recommending a heart-healthy diet. Nonalcoholic fatty liver disease (NAFLD) can progress to liver cirrhosis. There is no definitive treatment, and therapy is directed at reduction of risk factors, which include treatment of diabetes, reduction in body weight, and elimination of harmful medications. For patients who are overweight, weight reduction is important. Weight loss improves insulin sensitivity and reduces liver enzyme levels. No specific dietary therapy is recommended. However, a heart-healthy diet as recommended by the American Heart Association is appropriate.

Teaching in relation to home management after a laparoscopic cholecystectomy should include a. keeping the bandages on the puncture sites for 48 hours. b. reporting any bile-colored drainage or pus from any incision. c. using over-the-counter antiemetics if nausea and vomiting occur. d. emptying and measuring the contents of the bile bag from the T tube every day.

b. reporting any bile-colored drainage or pus from any incision. The following discharge instructions are taught to the patient and caregiver after a laparoscopic cholecystectomy: First, remove the bandages on the puncture site the day after surgery and shower. Second, notify the surgeon if any of the following signs and symptoms occur: redness, swelling, bile-colored drainage or pus from any incision; and severe abdominal pain, nausea, vomiting, fever, or chills. Third, gradually resume normal activities. Fourth, return to work within 1 week of surgery. Fifth, resume a usual diet, but a low-fat diet is usually better tolerated for several weeks after surgery

A portocaval shunt is considered for a patient with cirrhosis following an episode of bleeding esophageal varices. The nurse plans to teach the patient that this procedure a. is likely to improve the patient's life expectancy. b. will increase the risk of hepatic encephalopathy. c. will help to decrease the incidence of peritonitis. d. is a first-line therapy for portal hypertension.

b. will increase the risk of hepatic encephalopathy. The risk for hepatic encephalopathy increases after shunt procedures because blood bypasses the portal system and ammonia is diverted past the liver and into the systemic circulation. Life expectancy is not improved. The risk for peritonitis is not decreased by a surgical procedure, which will increase infection risk. First-line procedures for portal hypertension are medications such as diuretics and albumin.

The nurse reviews the records of a client diagnosed with Laennec's cirrhosis. The nurse expects to find which lab value? a) Serum albumin 4.0g/dL b) Serum aspirate aminotransferase (AST, SGOT) 38 units c) Serum alanine amino-transaminase (ALT, SGPT) 600 units d) Serum lactate dehydrogenase (LDH) 150 units

c) Serum alanine amino-transaminase (ALT, SGPT) 600 units Elevation indicates liver damage; normal is 5-35 units. Albumin synthesis depends on normal liver function and is decreased in liver disease; normal is 3.5-5.5 g/dL. AST are enzymes that are released from liver due to damaged cells and elevated in liver damage; normal is 10-40 U/L. LDH is elevated in liver disease; normal is 100-200 units.

Which enzyme aids in the digestion of protein? a) Ptyalin b) Pepsin c) Trypsin d) Lipase

c) Trypsin Trypsin, amylase, and lipase are digestive enzymes secreted by the pancreas. Trypsin aids in digesting protein; amylase aids in digesting starch; and lipase aids in digesting fats. Pepsin, an important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells.

An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to a) monitor blood glucose levels b) restrict fluid and sodium intake c) administer potassium sparing diuretics d) advise the patient to make postural changes slowly

c) administer K sparing diuretics Before surgery, patients should be treated with potassium-sparing diuretics (spironolactone [Aldactone], eplerenone [Inspra]) to normalize serum potassium levels. Spironolactone and eplerenone block the binding of aldosterone to the mineralocorticoid receptor in the terminal distal tubules and collecting ducts of the kidney, thus increasing sodium excretion, water excretion, and potassium retention. Oral potassium supplements may also be necessary.

The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral edema related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective? a. "It is safe to take acetaminophen up to four times a day for pain." b. "Lactulose (Cephulac) should be taken every day to prevent constipation." c. "Herbs and other spices should be used to season my foods instead of salt." d. "I will eat foods high in potassium while taking spironolactone (Aldactone)."

c. "Herbs and other spices should be used to season my foods instead of salt." A low-sodium diet is indicated for the patient with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided. Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. Pain medications such as acetaminophen, aspirin, and ibuprofen should be avoided as these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs. Spironolactone is a potassium-sparing diuretic. Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces.

A patient who is on corticosteroid therapy treatment for an autoimmune disorder has the following additional drugs ordered. Which one is used to prevent corticosteroid-induced osteoporosis? a. Potassium b. Furosemide (Lasix) c. Alendronate (Fosamax) d. Pantoprazole (Protonix)

c. Alendronate (Fosamax) Alendronate (Fosamax) is used to prevent corticosteroid-induced osteoporosis. Potassium is used to prevent the minaralcorticoid effect of hypokalemia. Furosemide (Lasix) is used to decrease sodium and fluid retention from the mineralcorticoid effect. Pantoprazole (Protonix) is used to prevent GI irritation from an increase in secretion of pepsin and HCl.

A nurse is admitting a client who has acute pancreatitis. Which of the following actions should the nurse take first? a. insert a NG tube b. administer ceftazidime c. Identify the clients current level of pain d. Instruct the client to remain NPO

c. Identify the clients current level of pain The first action the nurse should take when using the nursing process is toa assess the client. Clients who have acute pancreatitis often have severe abdominal pain. By assessing the client's level of pain, the nurse can identify the need for and implement interventions to alleviate the client's pain. Client's who have acute pancreatitis are at a risk for paralytic ileus and might require gastric decompression. The nurse should insert a NG tube if prescribed. Clients are also at risk for infection and the nurse should administer prescribed antibiotics. Clients are often placed on NPO status to decrease stress on the pancreas. The nurse should explain this intervention to the client. All of these things should be done after assessing the client.

During treatment of a patient with a Minnesota balloon tamponade for bleeding esophageal varices, which nursing action will be included in the plan of care? a. Encourage the patient to cough and deep breathe. b. Insert the tube and verify its position q4hr. c. Monitor the patient for shortness of breath. d. Deflate the gastric balloon q8-12hr.

c. Monitor the patient for shortness of breath. The most common complication of balloon tamponade is aspiration pneumonia. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. The health care provider inserts the tube and verifies the position. The esophageal balloon is deflated every 8 to 12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway.

Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices? a. Spironolactone (Aldactone) b. Cimetidine (Tagamet) c. Vasopressin (Pitressin) d. Nitroglycerin

c. Vasopressin (Pitressin) Vasopressin may be the initial therapy for esophageal varices, because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Aldactone and Tagamet do not decrease portal hypertension.

A patient with cirrhosis who is being treated with spironolactone (Aldactone) and furosemide (Lasix) has a serum sodium level of 135 mEq/L (135 mmol/L) and serum potassium 3.2 mEq/L (3.2 mmol/L). Before notifying the health care provider, the nurse should a. administer the furosemide and withhold the spironolactone. b. give both drugs as scheduled. c. administer the spironolactone. d. withhold both drugs until talking with the health care provider.

c. administer the spironolactone. Spironolactone is a potassium-sparing diuretic and will help to increase the patient's potassium level. The nurse does not need to talk with the doctor before giving the spironolactone, although the health care provider should be notified about the low potassium value. The furosemide will further decrease the patient's potassium level and should be held until the nurse talks with the health care provider.

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. prothrombin time. b. bilirubin levels. c. ammonia levels. d. potassium levels.

c. ammonia levels. The blood in the GI tract will be absorbed as protein and may result in an increase in ammonia level since the liver cannot metabolize protein well. The prothrombin time, bilirubin, and potassium levels should also be monitored, but these will not be affected by the bleeding episode.

A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include a. hypernatremia and edema. b. muscle spasticity and hypertension. c. low urine output and hyponatremia. d. weight gain and decreased glomerular filtration rate.

c. low urine output and hyponatremia. Excess ADH increases the permeability of the renal distal tubule and collecting ducts, which leads to the reabsorption of water into the circulation. Consequently, extracellular fluid volume expands, plasma osmolality declines, the glomerular filtration rate increases, and sodium levels decline (i.e., dilutional hyponatremia). Hyponatremia causes muscle cramping, pain, and weakness. Initially, the patient displays thirst, dyspnea on exertion, and fatigue. Patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) experience low urinary output and increased body weight. As the serum sodium level falls (usually to less than 120 mEq/L), manifestations become more severe and include vomiting, abdominal cramps, muscle twitching, and seizures. As plasma osmolality and serum sodium levels continue to decline, cerebral edema may occur, leading to lethargy, anorexia, confusion, headache, seizures, and coma.

A patient with severe cirrhosis has a new prescription for propranolol (Inderal). The nurse will teach the patient that the medication is ordered to a. decrease systemic BP. b. prevent the development of ischemia. c. lower the risk for bleeding varices. d. reduce fluid retention and edema.

c. lower the risk for bleeding varices. Beta-blockers have been shown to decrease the risk for bleeding in esophageal varices. Although propranolol will decrease BP and prevent cardiac ischemia, these are not the purposes for this patient. Propranolol will not decrease fluid retention or edema.

After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will plan to do discharge teaching about the need for a. insulin use to maintain blood glucose at normal levels. b. sodium restriction to prevent fluid retention and hypertension. c. oral corticosteroids to replace endogenous cortisol. d. chemotherapy to prevent reoccurrence of the tumor.

c. oral corticosteroids to replace endogenous cortisol. ADH, cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy. Without the effects of ACTH and cortisol, the blood glucose and serum sodium will be low unless cortisol is replaced. An adenoma is a benign tumor, and chemotherapy will not be needed.

A patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. The nurse explains to the patient that the major purpose of this treatment is a. control of fluid and electrolyte imbalance. b. relief from nausea and vomiting. c. reduction of pancreatic enzymes. d. removal of the precipitating irritants.

c. reduction of pancreatic enzymes. Pancreatic enzymes are released when the patient eats. NG suction and NPO status decrease the release of these enzymes. Fluid and electrolyte imbalances will be caused by NG suction and require that the patient receive IV fluids to prevent this. The patient's nausea and vomiting may decrease, but this is not the major reason for these treatments. The pancreatic enzymes that precipitate the pancreatitis are not removed by NG suction.

A patient with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find? a) A deficient amount of somatostatin b) An increase in antidiuretic hormone c) An increase in oxytocin d) A deficient production of vasopressin

d) A deficient production of vasopressin The most common disorder related to posterior lobe dysfunction is diabetes insipidus, a condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin. Diabetes insipidus may occur following surgical treatment of a brain tumor, secondary to nonsurgical brain tumors, and traumatic brain injury.

Which statement indicates a need for further teaching by a student nurse about nutritional therapy in patients with acute pancreatitis? a. "I should feed the patient through a nasojejunal tube." b. "I should monitor the patient's blood triglyceride levels." c. "I should give small quantities of food frequently to the patient." d. "I should include fat-rich food substances in the patient's dietary plan."

d. "I should include fat-rich food substances in the patient's dietary plan." Patients with acute pancreatitis should be provided with food that does not stimulate the pancreas much. Fats are broken down by the enzymes produced by pancreas; therefore, fat-rich food substances should not be given to the patient. Patients with pancreatitis are given nasojejunal tube feeding. Patients with pancreatitis have malfunctioning of the pancreas, and therefore do not metabolize fats. If fat-rich substances or intravenous lipids are given, then the blood triglyceride level may rise. Therefore, the nurse should monitor the patient's blood triglyceride levels. To avoid burden on the pancreas, feedings should be given frequently in small quantities.

A client with a history of alcohol abuse was admitted with bleeding esophageal varices. After several days of treatment, the client is ready for discharge. The nurse enters the client's room to review discharge instructions with the client when he tells the nurse that he wants help to quit drinking. How should the nurse respond? a. "Let me finish reviewing your discharge instructions, then we can discuss your concerns." b. "I'll tell your family so they can make arrangements for you to enter an alcohol rehabilitation center." c. "I hope it isn't too late; you've already done a lot of damage to your liver." d. "I'll notify your physician and call the social worker so she can discuss treatment options with you."

d. "I'll notify your physician and call the social worker so she can discuss treatment options with you." The nurse should notify the physician and call the social worker so the social worker can discuss treatment options with the client. The social worker may be able to arrange inpatient treatment for the client immediately after discharge if the client wishes. Telling the client to wait to discuss his concerns minimizes his feelings. Telling the family about the client's wishes breaches client confidentiality.

The nurse is reviewing the home medication list for a 44-year-old man admitted with suspected hepatic failure. Which medication could cause hepatotoxicity? a. Nitroglycerin b. Digoxin (Lanoxin) c. Ciprofloxacin (Cipro) d. Acetaminophen (Tylenol)

d. Acetaminophen (Tylenol) Many chemicals and drugs are potentially hepatotoxic (see Table 39-6) and result in significant patient harm unless monitored closely. For example, chronic high doses of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) may be hepatotoxic.

A patient reports severe pain in the abdomen to a nurse. The nurse finds the patient's body temperature is 100° F. The laboratory reports show a white blood cell (WBC) count of 13,000/μL, lipase of 180 U/L, and amylase of 150 U/L. What finding does the nurse anticipate? a. Hepatitis b. Cholelithiasis c. Liver cirrhosis d. Acute pancreatitis

d. Acute pancreatitis Acute pancreatitis is manifested by abdominal pain, low-grade fever, tachycardia, leukocytosis, and elevated amylase and lipase values. A normal WBC count is 4,000 to 11,000/μL, a normal lipase range is 0 to 160 U/L, and a normal amylase range is 30 to 122U/L. The patient's laboratory values of WBC at 13,000/μL, lipase at 180 U/L, and amylase at 150 U/L indicate leukocytosis and high lipase and amylase levels. Nausea, vomiting, arthralgias, and jaundice are manifestations of hepatitis. Cholelithiasis is manifested by pain, fever, and jaundice. Liver cirrhosis is manifested by skin lesions, leucopenia, and endocrine problems, such as gynaecomastia in men or amenorrhea in women.

A nurse is reviewing the laboratory results of a client who has hepatic cirrhosis. Which of the following laboratory findings should the nurse report to the provider? a. Albumin 4.0 g/dL b. INR 1.5 c. Bilirubin 0.2 mg/dL d. Ammonia 180 mcg/dL

d. Ammonia 180 mcg/dL The nurse should report an increased serum ammonia level because it can indicate portal-systemic encephalopathy. All other labs are within the expected reference ranges.

A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question because it is most likely to cause hepatic complications? a. Tramadol (Ultram) b. Hydromorphone (Dilaudid) c. Oxycodone with aspirin (Percodan) d. Hydrocodone with acetaminophen (Vicodin)

d. Hydrocodone with acetaminophen (Vicodin) The analgesic with acetaminophen should be questioned because this patient is a chronic carrier of hepatitis B and is likely to have impaired liver function. Acetaminophen is not suitable for this patient because it is converted to a toxic metabolite in the liver after absorption, increasing the risk of hepatocellular damage.

When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis? a. Impaired skin integrity related to edema, ascites, and pruritus b. Imbalanced nutrition: less than body requirements related to anorexia c. Excess fluid volume related to portal hypertension and hyperaldosteronism d. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

d. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priorities.

Which data obtained by the nurse during the assessment of a patient with cirrhosis will be of most concern? a. The patient's skin has multiple spider-shaped blood vessels on the abdomen. b. The patient has ascites and a 2-kg weight gain from the previous day. c. The patient complains of right upper-quadrant pain with abdominal palpation. d. The patient's hands flap back and forth when the arms are extended.

d. The patient's hands flap back and forth when the arms are extended. The asterixis indicates that the patient has hepatic encephalopathy, and hepatic coma may occur. The spider angiomas and right upper-quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment. The ascites and weight gain do indicate the need for treatment but not as urgently as the changes in neurologic status.

When a patient eats a bag of potato chips, the nurse recognizes that hypernatremia is likely to occur if the patient is experiencing a decreased production of a. cortisol. b. aldosterone. c. pancreatic somatostatin. d. antidiuretic hormone (ADH).

d. antidiuretic hormone (ADH). If the patient has decreased ADH, the renal tubules will not reabsorb water and the serum sodium level will increase. Cortisol and aldosterone will increase sodium and water reabsorption in the kidney, which tends to keep serum sodium stable. Somatostatin does not affect serum sodium levels.

When lactulose (Cephulac) 30 ml QID is ordered for a patient with advanced cirrhosis, the patient complains that it causes diarrhea. The nurse explains to the patient that it is still important to take the drug because the lactulose will a. promote fluid loss. b. prevent constipation. c. prevent gastrointestinal (GI) bleeding. d. improve nervous system function.

d. improve nervous system function. The purpose for lactulose in the patient with cirrhosis is to lower ammonia levels and prevent encephalopathy. Although the medication may promote fluid loss through the stool, prevent constipation, and prevent bearing down during bowel movements (which could lead to esophageal bleeding), the medication is not ordered for these purposes for this patient.

Vasopressin is administered to the client with diabetes insipidus because it: a. increases release of insulin from the pancreas. b. decreases glucose production within the liver. c. increases tubular reabsorption of water. d. decreases blood pressure.

increases tubular reabsorption of water. The major characteristic of diabetes insipidus is decreased tubular reabsorption of water due to insufficient amounts of antidiuretic hormone (ADH). Vasopressin is administered to the client with diabetes insipidus because it has pressor and ADH activities. Vasopressin works to increase the concentration of the urine by increasing tubular reabsorption, thus preserving up to 90% water. Vasopressin is administered to the client with diabetes insipidus because it is a synthetic ADH. The administration of vasopressin results in increased tubular reabsorption of water, and it is effective for emergency treatment or daily maintenance of mild diabetes insipidus. Vasopressin does not decrease blood pressure or affect insulin production or glucose metabolism, nor is insulin production a factor in diabetes insipidus.

A nurse is teaching a patient about the types of chronic liver disease. The patient's teaching is determined to be effective based on the correct identification of which of the following types of cirrhosis caused by scar tissue surrounding the portal areas? a. Biliary cirrhosis b. Compensated cirrhosis c. Alcoholic cirrhosis d. Postnecrotic cirrhosis

Alcoholic cirrhosis Alcoholic cirrhosis, in which the scar tissue characteristically surrounds the portal areas, is most frequently caused by chronic alcoholism and is the most common type of cirrhosis. In postnecrotic cirrhosis, there are broad bands of scar tissue, which are a late result of a previous acute viral hepatitis. In biliary cirrhosis, scarring occurs in the liver around the bile ducts. Compensated cirrhosis is a general term given to the state of liver disease in which the liver continues to be able to function effectively.

A patient has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this patient? A) Oral oxycodone B) IV hydromorphone (Dilaudid) C) IM meperidine (Demerol) D) Oral naproxen (Aleve)

B) IV hydromorphone (Dilaudid) The pain of acute pancreatitis is often very severe and pain relief may require parenteral opioids such as morphine, fentanyl (Sublimaze), or hydromorphone (Dilaudid). There is no clinical evidence to support the use of meperidine for pain relief in pancreatitis. Opioids are preferred over NSAIDs.

A nurse is preparing a plan of care for a patient with pancreatic cysts that have necessitated drainage through the abdominal wall. What nursing diagnosis should the nurse prioritize? A) Disturbed Body Image B) Impaired Skin Integrity C) Nausea D) Risk for Deficient Fluid Volume

B) Impaired Skin Integrity While each of the diagnoses may be applicable to a patient with pancreatic drainage, the priority nursing diagnosis is Impaired Skin Integrity. The drainage is often perfuse and destructive to tissue because of the enzyme contents. Nursing measures must focus on steps to protect the skin near the drainage site from excoriation. The application of ointments or the use of a suction apparatus protects the skin from excoriation.

A nurse is caring for a patient who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this patient, the nurse should describe what aspect of this diagnostic procedure? A) The need to protect the incision postprocedure B) The use of moderate sedation C) The need to infuse 50% dextrose during the procedure D) The use of general anesthesia

B) The use of moderate sedation Moderate sedation, not general anesthesia, is used during ERCP. D50 is not administered and the procedure does not involve the creation of an incision.

The client has been diagnosed with hypothyroidism. What medication is usually prescribed to treat this disease? A. Atenolol (Tenormin) B. Levothyroxine sodium (Synthroid) C. Methimazole (Tapazole) D. Propylthiouracil (PTU)

B. Levothyroxine sodium (Synthroid) Levothyroxine is a synthetic form of T4 that is used to treat hypothyroidism. Atenolol is a beta blocker that is used to treat cardiovascular disease. Methimazole is used to treat hyperthyroidism. Propylthiouracil is used to treat hyperthyroidism.

The family of a patient in the ICU diagnosed with acute pancreatitis asks the nurse why the patient has been moved to an air bed. What would be the nurse's best response? A) "Air beds allow the care team to reposition her more easily while she's on bed rest." B) "Air beds are far more comfortable than regular beds and she'll likely have to be on bed rest a long time." C) "The bed automatically moves, so she's less likely to develop pressure sores while she's in bed." D) "The bed automatically moves, so she is likely to have less pain."

C) "The bed automatically moves, so she's less likely to develop pressure sores while she's in bed." It is important to turn the patient every 2 hours; use of specialty beds may be indicated to prevent skin breakdown. The rationale for a specialty bed is not related to repositioning, comfort, or ease of movement.

A nurse who provides care in a walk-in clinic assesses a wide range of individuals. The nurse should identify which of the following patients as having the highest risk for chronic pancreatitis? A) A 45-year-old obese woman with a high-fat diet B) An 18-year-old man who is a weekend binge drinker C) A 39-year-old man with chronic alcoholism D) A 51-year-old woman who smokes one-and-a-half packs of cigarettes per day

C) A 39-year-old man with chronic alcoholism Excessive and prolonged consumption of alcohol accounts for approximately 70% to 80% of all cases of chronic pancreatitis.

A patient has been admitted to the hospital for the treatment of chronic pancreatitis. The patient has been stabilized and the nurse is now planning health promotion and educational interventions. Which of the following should the nurse prioritize? A) Educating the patient about expectations and care following surgery B) Educating the patient about the management of blood glucose after discharge C) Educating the patient about postdischarge lifestyle modifications D) Educating the patient about the potential benefits of pancreatic transplantation

C) Educating the patient about postdischarge lifestyle modifications The patient's lifestyle (especially regarding alcohol use) is a major determinant of the course of chronic pancreatitis. The disease is not often managed by surgery and blood sugar monitoring is not necessarily indicated for every patient after hospital treatment. Transplantation is not an option.

A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication? A) Sudden increase in random blood glucose readings B) Increased abdominal girth accompanied by decreased level of consciousness C) Fever, increased heart rate and decreased blood pressure D) Abdominal pain unresponsive to analgesics

C) Fever, increased heart rate and decreased blood pressure Pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis because of resulting hemorrhage, septic shock, and multiple organ dysfunction syndrome (MODS). Signs of shock would include hypotension, tachycardia and fever. Each of the other listed changes in status warrants intervention, but none is clearly suggestive of an onset of pancreatic necrosis.

A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize which of the following topics? A) Management of fluid balance in the home setting B) The need for blood glucose monitoring for the next week C) Signs and symptoms of intra-abdominal complications D) Appropriate use of prescribed pancreatic enzymes

C) Signs and symptoms of intra-abdominal complications Because of the early discharge following laparoscopic cholecystectomy, the patient needs thorough education in the signs and symptoms of complications. Fluid balance is not typically a problem in the recovery period after laparoscopic cholecystectomy. There is no need for blood glucose monitoring or pancreatic enzymes.

When caring for a patient with advanced cirrhosis and hepatic encephalopathy, which of the following assessment findings should the nurse report immediately? a. Constipation for more than 2 days b. Weight loss of 2 pounds in 3 days c. Anorexia for more than 3 days d. Change in the patient's handwriting and or cognitive performance

Change in the patient's handwriting and or cognitive performance The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. The patient appears confused and unkempt and has alterations in mood and sleep patterns. Neurologic status should be assessed frequently. Mental status is monitored by the nurse keeping the patient's daily record of handwriting and arithmetic performance. The nurse should report any change in mental status immediately. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis..

A patient who is hospitalized with abdominal pain and watery, incontinent diarrhea is diagnosed with Clostridium difficile. In planning care for the patient, the nurse will a. order a diet with no dairy products for the patient. b. place the patient in a private room with contact isolation. c. explain to the patient why antibiotics are not being used. d. teach the patient about proper food handling and storage.

Correct Answer: B Rationale: Because C. difficile is highly contagious, the patient should be placed in a private room and contact precautions should be used. There is no need to restrict dairy products for this type of diarrhea. Metronidazole (Flagyl) is frequently used to treat C. difficile. Improper food handling and storage do not cause C. difficile.

The hypothalamus secretes releasing hormones and inhibiting hormones. What is the target tissue of these releasing hormones and inhibiting hormones? A) Pineal B) Adrenal cortex C) Posterior pituitary D) Anterior pituitary

D) Anterior pituitary The anterior pituitary is the target tissue of the releasing hormones (corticotropin releasing hormone, thyrotropin releasing hormone, growth hormone releasing factor, gonadotropin releasing hormone, prolactin releasing factor) and the inhibiting hormones (somatostatin, prolactin inhibiting factor). These hormones release or inhibit other hormones that affect the thyroid, adrenal cortex, pancreas, reproductive organs, and all body cells. The pineal gland is not directly affected by the releasing and inhibiting hormones from the hypothalamus. The posterior pituitary releases antidiuretic hormone (ADH) in response to plasma osmolality changes that is not directly affected by the hypothalamus hormones.

A patient has been treated in the hospital for an episode of acute pancreatitis. The patient has acknowledged the role that his alcohol use played in the development of his health problem, but has not expressed specific plans for lifestyle changes after discharge. What is the nurse's most appropriate response? A) Educate the patient about the link between alcohol use and pancreatitis. B) Ensure that the patient knows the importance of attending follow-up appointments. C) Refer the patient to social work or spiritual care. D) Encourage the patient to connect with a community-based support group.

D) Encourage the patient to connect with a community-based support group. After the acute attack has subsided, some patients may be inclined to return to their previous drinking habits. The nurse provides specific information about resources and support groups that may be of assistance in avoiding alcohol in the future. Referral to Alcoholics Anonymous as appropriate or other support groups is essential. The patient already has an understanding of the effects of alcohol, and follow-up appointments will not necessarily result in lifestyle changes. Social work and spiritual care may or may not be beneficial.

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a. Hypotension b. Polyuria c. Bradycardia d. Warm moist skin

Hypotension Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased BP, and decreased urine output.

A patient with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade therapy is used temporarily to control hemorrhage and stabilize the patient. In planning care, the nurse gives the highest priority to which of the following goals? a. Relieving the patient's anxiety b. Maintaining fluid volume c. Controlling bleeding d. Maintaining the airway

Maintaining the airway Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway is compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.

The nurse is teaching the client about the upcoming endoscopic retrograde cholangiopancreatography (ERCP). Although the nurse instructs on several pertinent points of care, which is emphasized? a) The client will change positions frequently throughout the procedure. b) The client will have moderate sedation. c) The client will fast prior to the procedure. d) The client will receive antibiotics before and after the procedure.

The client will change positions frequently throughout the procedure. It is essential that the client understands that the cooperation is essential in changing positions throughout the procedure to prevent injury of the gastrointestinal tract. All of the other options are also correct but do not carry a risk for injury if not completed.

The nurse instructs a 28-year-old man with acromegaly resulting from an unresectable benign pituitary tumor about octreotide (Sandostatin). The nurse should intervene if the patient makes which statement? a) "I will come in to receive this medication IV every 2 to 4 weeks." b) "I will inject the medication in the subcutaneous layer of the skin." c) "The medication will decrease the growth hormone production to normal." d) "If radiation treatment is not effective, I may need to take the medication."

a) "I will come in to receive this medication IV every 2 to 4 weeks." Drugs are most commonly used in patients who have had an inadequate response to or cannot be treated with surgery and/or radiation therapy. The most common drug used for acromegaly is octreotide (Sandostatin), a somatostatin analog that reduces growth hormone levels to within the normal range in many patients. Octreotide is given by subcutaneous injection three times a week. Two long-acting analogs, octreotide (Sandostatin LAR) and lanreotide SR (Somatuline Depot), are available as intramuscular (IM) injections given every 2 to 4 weeks.

The nurse cares for a patient after a traditional cholecystectomy. The nurse should contact the physician if which of the following is observed? a) 800 cc bloody drainage in the first day postop b) The patient frequently complains of abdominal pain during the first 24 hours c) Nasogastric tube connected to intermittent suction the first day postop d) Temperature elevation to 100ºF the evening of the surgery

a) 800 cc bloody drainage the first day postop this amount of drainage after a cholecystectomy would indicate hemorrhage; 50 cc is an appropriate amount of drainage

After cholecystectomy, a patient is returned to the unit with a nasogastric tube connected to low intermittent suction, an IV of D5W, a T-tube in place and a Penrose drain. The nurse understands that the purpose of the Penrose drain includes which of the following? a) Remove accumulated bile and blood after surgery b) Permit irrigation of the peritoneum with an antibiotic solution c) Provide access to the cystic duct postop d) Provide a route for alimentation

a) Remove accumulated bile and blood after surgery duct must be allowed to drain; bile would otherwise drain into surrounding tissue, be very caustic, and cause problems for the patient

The nurse is preparing a care plan for a patient with hepatic cirrhosis. Which of the following nursing diagnoses are appropriate? Select all that apply. a. Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort b. Altered nutrition, more than body requirements, related to decreased activity and bed rest c. Risk for injury related to altered clotting mechanisms d. Urinary incontinence related to general debility and muscle wasting e. Disturbed body image related to changes in appearance, sexual dysfunction, and role function

a. Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort c. Risk for injury related to altered clotting mechanisms e. Disturbed body image related to changes in appearance, sexual dysfunction, and role function Risks for injury, activity intolerance, and disturbed body image are priority nursing diagnoses. The appropriate nursing diagnosis related to nutrition would be altered nutrition, less than body requirements, related to chronic gastritis, decreased GI motility, and anorexia. Urinary incontinence is not generally a concern with hepatic cirrhosis.

While caring for a patient with pancreatitis, a nurse finds that the patient's blood pressure is 80/70 mm Hg and the nurse suspects hypovolemia. Which treatment option does the nurse expect to be effective? a. Administration of albumin b. Administration of octreotide c. Administration of cyclosporine d. Administration of acetazolamide

a. Administration of albumin Acute pancreatitis may cause shock, which is manifested by decreased volume of body fluids and reduced circulatory volume, which results in decreased blood pressure. Albumin is a plasma volume expander which should be administered to help restore the circulatory volume. Octreotide is a drug used to treat esophageal varices in patients with liver cirrhosis. Cyclosporine is a calcineurine inhibitor used as an immunosuppressive drug in patients with liver transplantation. Acetazolamide is a carbonic anhydrase inhibitor used to decrease the volume and bicarbonate concentration of pancreatic secretion in patients with acute pancreatitis.

A patient complaining of shortness of breath is admitted with the diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? a. Albumin b. Hemoglobin c. Bilirubin d. Temperature

a. Albumin With the movement of albumin from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure, results in movement of fluid into the peritoneal cavity. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of ascites and edema.

What are two effects of hypokalemia on the endocrine system? a. Decreased insulin and aldosterone release b. Decreased glucagon and increased cortisol release c. Decreased release of atrial natriuretic factor and increased ADH release d. Decreased release of parathyroid hormone and increased calcitonin release

a. Decreased insulin and aldosterone release Hypokalemia inhibits aldosterone release as well as insulin release.

A patient with acromegaly is treated with a transsphenoidal hypophysectomy. What should the nurse do postoperatively? a. Ensure that any clear nasal drainage is tested for glucose b. Maintain the patient flat in bed to prevent cerebrospinal fluid (CSF) leakage. c. Assist the patient with toothbrushing every 4 hours to keep the surgical area clean d. Encourage deep breathing, coughing, and turning to prevent respiratory complications

a. Ensure that any clear nasal drainage is tested for glucose A transsphenoidal hypophysectomy involves entry into the sella turcica through an incision in the upper lip ans gingiva into the floor of the nose and the sphenoid sinuses. Postoperative clear nasal drainage with glucose content indicates CSF leakage from an open connection to the brain, putting the patient at risk for meningitis. After surgery, the patient is positioned with the head elevated to avoid pressure on the sella turcica. Coughing and straining are avoided to prevent increased ICP and CSF leakage. Although mouth care is required every 4 hours, toothbrushing should not be performed because injury to the suture line may occur.

When caring for a patient with primary hyperaldosteronism, the nurse would question a health care provider's prescription for which drug? a. Furosemide (Lasix) b. Amiloride (Midamor) c. Spironolactone (Aldactone) d. Aminoglutethimide (Cytadren)

a. Furosemide (Lasix) Hyperaldosteronism is an excess of aldosterone, which is manifested by sodium and water retention and potassium excretion. Furosemide is a potassium-wasting diuretic that would increase the potassium deficiency. Aminoglutethimide blocks aldosterone synthesis. Spironolactone and amiloride are potassium-sparing diuretics.

The nurse is assessing a patient with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply. a. Insomnia b. Alterations in mood c. Decreased deep tendon reflexes d. Agitation e. Complaints of headache

a. Insomnia b. Alterations in mood d. Agitation The earliest symptoms of hepatic encephalopathy include both mental status changes and motor disturbances. The patient appears confused and unkempt and has alterations in mood and sleep patterns. The patient tends to sleep during the day and has restlessness and insomnia at night. To assess for mental deterioration, the nurse will assess general behavior, orientation, and speech as well as cognitive abilities and speech patterns.

A patient with acute pancreatitis reports severe abdominal pain. What medication does the nurse anticipate administering to the patient to alleviate the pain? a. Morphine b. Omeprazole c. Pancrelipase d. Acetazolamide

a. Morphine Morphine is an opioid analgesic that relieves acute, severe pain. Omeprazole is an antacid that decreases gastric acid secretion. Pancrelipase is a synthetic product used for pancreatic enzyme replacement in patients with chronic pancreatitis. Acetazolamide is a diuretic and is not effective in relieving pain.

Which action of the student nurse indicates effective learning about determining the effectiveness of pancreatic enzymes replacement in patients with chronic pancreatitis? a. Observing the patient's stool b. Observing the patient's urine c. Observing the patient's saliva d. Observing the patient's nasal secretions

a. Observing the patient's stool Patients with pancreatitis have diminished or absent pancreatic lipases, the enzymes that break down fat. This leads to steatorrhea, which is characterized by greasy and foul-smelling stools. Therefore, observing the patient's stool for steatorrhea helps to determine the effectiveness of pancreatic enzymes. Though dry mouth and dark urine are manifestations of pancreatitis, the effectiveness of enzymes cannot be determined by observing the urine and saliva. There is no change in the patient's nasal secretions. Therefore, observing nasal secretions will not be helpful in determining enzyme efficiency.

The nurse is caring for a patient who has an increase in gastric acid that is causing epigastric pain. Which drug does the nurse anticipate administering to the patient to reduce the gastric acid secretion? a. Omeprazole b. Dicyclomine c. Nitroglycerine d. Acetazolamide

a. Omeprazole Omeprazole is a proton pump inhibitor that acts by decreasing production of hydrochloric acid in the stomach. Dicyclomine is an antispasmodic used to relieve muscle spasms. Nitroglycerine is an example of a vasodilator drug, which dilates the blood vessels and is used to relax the smooth muscles. Acetazolamide is a carbonic anhydrase inhibitor used to decrease the volume and concentration of bicarbonate in pancreatic secretions.

The nurse administers lactulose to a client with cirrhosis. What is the expected outcome from the administration of the lactulose? a. Reduced serum ammonia levels. b. Reduced peripheral edema and ascites. c. Stimulation of peristalsis of the bowel. d. Prevention of hemorrhage.

a. Reduced serum ammonia levels. Lactulose is used to treat hepatic encephalopathy by reducing serum ammonia levels. It is not used to stimulate bowel peristalsis, even though diarrhea can be a side effect of the drug. Lactulose does not have any effect on edema, ascites, or hemorrhage.

The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons (select all that apply)? a. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. b. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. c. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity. d. Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluids orally. e. Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which decreases the vascular pressure.

a. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. b. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. c. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity. The ascites related to cirrhosis are caused by decreased colloid oncotic pressure from the lack of albumin from liver inability to synthesize it and the portal hypertension that shifts the protein from the blood vessels to the peritoneal cavity, and hyperaldosteronism which increases sodium and fluid retention. The intake of fluids orally and the removal of blood cells by the spleen do not directly contribute to ascites.

Nursing management of the patient with acute pancreatitis includes (select all that apply) a. checking for signs of hypocalcemia. b. providing a diet low in carbohydrates. c. giving insulin based on a sliding scale. d. observing stools for signs of steatorrhea. e. monitoring for infection, particularly respiratory tract infection.

a. checking for signs of hypocalcemia. e. monitoring for infection, particularly respiratory tract infection. During the acute phase, it is important to monitor vital signs. Hemodynamic stability may be compromised by hypotension, fever, and tachypnea. Intravenous fluids are ordered, and the response to therapy is monitored. Fluid and electrolyte balances are closely monitored. Frequent vomiting, along with gastric suction, may result in decreased levels of chloride, sodium, and potassium. Because hypocalcemia can occur in acute pancreatitis, the nurse should observe for symptoms of tetany, such as jerking, irritability, and muscular twitching. Numbness or tingling around the lips and in the fingers is an early indicator of hypocalcemia. The patient should be assessed for Chvostek's sign or Trousseau's sign. A patient with acute pancreatitis should be observed for fever and other manifestations of infection. Respiratory infections are common because the retroperitoneal fluid raises the diaphragm, which causes the patient to take shallow, guarded abdominal breaths.

Following a transsphenoidal resection of a pituitary tumor, an important nursing assessment is a. monitoring hourly urine output. b. checking the dressings for serous drainage. c. palpating for dependent pitting edema. d. obtaining continuous pulse oximetry.

a. monitoring hourly urine output. After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema and monitoring of urine output and urine specific gravity is essential. There will be no dressing when the transsphenoidal approach is used. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.

The nurse identifies the collaborative problem of potential complication: electrolyte imbalance for a patient with severe acute pancreatitis. Assessment findings that alert the nurse to electrolyte imbalances associated with acute pancreatitis include a. muscle twitching and finger numbness. b. paralytic ileus and abdominal distention. c. hypotension. d. hyperglycemia.

a. muscle twitching and finger numbness. Muscle twitching and finger numbness indicate hypocalcemia, a potential complication of acute pancreatitis. The other data indicate other complications of acute pancreatitis but are not indicators of electrolyte imbalance.

The health care provider prescribes pancreatin (Viokase) for a patient with chronic pancreatitis. The nurse teaches the patient that the drug is considered effective if the patient experiences a. normal-appearing stools. b. decreased jaundice. c. improved appetite. d. reduced abdominal pain.

a. normal-appearing stools. The patient's steatorrhea should improve if the pancreatic enzymes are effective. The pancreatin will not decrease jaundice, improve appetite, or reduce abdominal pain.

The nurse cares for a client with a Sengstaken-Blakemore tube to treat bleeding esophageal varices. The client suddenly develops respiratory distress. Which action should the nurse take FIRST? a) Auscultate breath sounds b) Cut the balloon port on the Sengstaken-Blakemore tube c) Obtain and record blood pressure and pulse d) Contact the health care provider

b) Cut the balloon port on the Sengstaken-Blakemore tube keep a pair of scissors at bedside; cutting the port will deflate the balloon and allow the nurse to remove the tube

Which symptoms of liver disease should the nurse expect to see in a client with Laënnec 's cirrhosis? a) Cloudy urine b) Dark urine c) Orange-colored stools d) Tarry stools

b) Dark urine Normally bilirubin is not excreted in urine; urine with abnormal bilirubin is mahogany-colored and has yellow foam when shaken; clients with cirrhosis may have clay-colored stools due to decreased fecal urobilinogen. Urine appears cloudy due to high protein concentrations (CKD) or as a result of infection, but not seen in cirrhosis. Tarry stools indicate bleeding and may be caused by gastritis or stomach ulceration.

The nurse identifies which diet BEST meets the nutritional needs of a client diagnosed with cirrhosis? a) High in calories plus vitamin supplements b) High in protein and high in carbohydrates c) High in calcium and low in fat d) High in iron and low in salt

b) High in protein and high in carbohydrates Since many alcoholics are malnourished, a high-protein diet is important; there will be no change in calcium or iron requirements, and only moderate amounts of fat are allowed; if cirrhosis accompanied by ascites, sodium may be restricted as well. There is no change in iron requirements. Vitamins may also be indicated

The nurse understands which of the following is the principal reason for the use of enzyme inhibitors (Diamox) in a patient with pancreatitis? a) Pancreatic enzymes are irritating to the liver b) Pancreatic enzymes escape into interstitial tissue c) Pancreatic enzymes are missing and must be replaced d) Pancreatic enzymes are inactivated and must be enhanced

b) Pancreatic enzymes escape into interstitial tissue Interstitial pancreatitis is characterized by a swelling of the gland and the escape of its digestive enzymes, lipase and amylase, into the surrounding tissue and into the peritoneal cavity, causing necrosis via autodigestion of the pancreas; Diamox helps inactivate these enzymes to help minimize the damage they would cause to normal tissue

Which medication is the treatment of choice for patients with hyperthyroidism who become pregnant? a) Methimazole (MMI) b) Propylthiouracil (PTU) c) Potassium iodide d) Supersaturated potassium iodide (SSKI)

b) Propylthiouracil (PTU) PTU is recommended during the first trimester of pregnancy rather than MMI due to the teratogenic effects of MMI. Due to the risk of hepatotoxicity, PTU should be discontinued after the first trimester and the patient should be switched to MMI for the remainder of the pregnancy and when nursing.

A patient's assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment questions address likely etiologic factors? Select all that apply. A) "How many alcoholic drinks do you typically consume in a week?" B) "Have you ever been tested for diabetes?" C) "Have you ever been diagnosed with gallstones?" D) "Would you say that you eat a particularly high-fat diet?" E) "Does anyone in your family have cystic fibrosis?"

A) "How many alcoholic drinks do you typically consume in a week?" C) "Have you ever been diagnosed with gallstones?" Eighty percent of patients with acute pancreatitis have biliary tract disease such as gallstones or a history of long-term alcohol abuse. Diabetes, high-fat consumption, and cystic fibrosis are not noted etiologic factors.

A nurse is managing the care of a client who is postoperative and experiencing acute adrenal insufficiency. Which of the following actions should the nurse take? A. Administer IV hydrocortisone sodium succinate. B. Give oral spironolactone. C. Infuse 1 unit of platelets. D. Restrict daily fluid intake.

A. Administer IV hydrocortisone sodium succinate. Hydrocortisone sodium succinate is necessary to replace the cortisol deficiency that occurs with adrenal insufficiency. Administering a potassium-sparing diuretic will further increase the client's potassium level, potentiating the state of hyperkalemia. Although this client needs to increase volume, infusing platelets is not indicated. Rapid fluid replacement is indicated for this client due to hypovolemia.

A patient is told to take replacement pancreatic enzymes to prevent malabsorption of fat. How should the enzymes be administered? A. Mixed in fruit juice B. Mixed in chocolate milk C. Enema D. IV infusion

A. Mixed in fruit juice Pancreatic enzymes are mixed in fruit juice or applesauce. They should not be mixed with a protein. They are administered by mouth.

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: A. vasopressin (Pitressin Synthetic). B. furosemide (Lasix). C. regular insulin. D. 10% dextrose.

A. vasopressin (Pitressin Synthetic). Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

When the nurse assesses the patient that has pancreatitis, what function may be altered related to the endocrine function of the pancreas? A) Blood glucose regulation B) Increased response to stress C) Fluid and electrolyte regulation D) Regulates metabolic rate of cells

A) Blood glucose regulation The endocrine functions of the pancreas are regulated by α cells that produce and secrete glucagon, β cells that produce and secrete insulin and amylin, delta cells that produce and secrete somatostatin, and F cells that secrete pancreatic polypeptide. Glucagon, insulin, and amylin, and somatostatin all affect blood glucose. Pancreatic polypeptide regulates appetite. Increased response to stress occurs from epinephrine secreted by the adrenal medulla. Fluid and electrolyte regulation occurs in response to several hormones (mineralocorticoids, antidiuretic hormone, parathyroid hormone, calcitonin) from several organs (adrenal cortex, posterior pituitary, parathyroid, thyroid). The metabolic rate of cells is regulated by triiodothyronine (T3) from the thyroid.

A patient has had a laparoscopic cholecystectomy. The patient is now complaining of right shoulder pain. What should the nurse suggest to relieve the pain? A) Aspirin every 4 to 6 hours as ordered B) Application of heat 15 to 20 minutes each hour C) Application of an ice pack for no more than 15 minutes D) Application of liniment rub to affected area

B) Application of heat 15 to 20 minutes each hour If pain occurs in the right shoulder or scapular area (from migration of the CO2 used to insufflate the abdominal cavity during the procedure), the nurse may recommend use of a heating pad for 15 to 20 minutes hourly, walking, and sitting up when in bed. Aspirin would constitute a risk for bleeding.

A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the RN's best response? A. "You should see effects of this medication immediately." B. "You should see effects of this medication within 1 week." C. "You should see full effects from this medication within 1 to 2 days." D. "You should see some effects of this medication within 2 weeks."

D. "You should see some effects of this medication within 2 weeks." Methimazole is an iodine preparation that decreases blood flow through the thyroid gland. This action reduces the production and release of thyroid hormone. The client should see some effects within 2 weeks; however, it may take several more weeks before metabolism returns to normal.Although onset of action is 30 to 40 minutes after an oral dose, the client will not see effects immediately. Effects will take longer than 1 week to become apparent when methimazole is used. Methimazole needs to be taken every 8 hours for an extended period of time. Levels of T3 and T4 will be followed and dosages adjusted as levels fall.

The nurse reviews the vital signs of the client diagnosed with Graves' disease and sees that the client's temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next? A. Administers acetaminophen B. Alerts the Rapid Response Team C. Asks any visitors to leave D. Assesses the client's cardiac status completely

D. Assesses the client's cardiac status completely If the client's temperature has increased by even 1°, the nurse's first action is to notify the health care provider. Continuous cardiac monitoring should be the next step. Administering a nonsalicylate antipyretic like acetaminophen is appropriate but is not a priority action for this client. Alerting the Rapid Response Team is not needed at this time. Asking visitors to leave would not be the next action, and if the visitors are providing comfort to the client, this would be contraindicated.

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A patient has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions? a. Cirrhosis b. Asterixis c. Hepatic encephalopathy d. Portal hypertension

Hepatic encephalopathy Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction. Cirrhosis is a chronic liver disorder characterized by fibrotic changes, the formation of dense connective tissue within the liver, subsequent degenerative changes, and loss of functional liver tissue.

Which of the following indicates an overdose of lactulose? a. Constipation b. Hypoactive bowel sounds c. Watery diarrhea d. Fecal impaction

Watery diarrhea The patient receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.

When reviewing the laboratory results for a patient's total calcium level, which information will the nurse need to consider? a. The serum albumin level is low. b. The phosphate level is normal. c. The blood glucose is elevated. d. The total protein is decreased.

a. The serum albumin level is low. Part of the total calcium is bound to albumin, so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not impact on total calcium interpretation.