Mastery quiz questions ch.30

A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs, "more fluids in my vein?" The nurse responds:

"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water." -Large-volume paracentesis (removal of 5 L or more of ascitic fluid) may be done in persons with massive ascites and pulmonary compromise. Because the removal of fluid produces a decrease in vascular volume along with increased plasma renin activity and aldosterone-mediated sodium and water reabsorption by the kidneys, a volume expander such as albumin usually is administered to maintain the effective circulating volume. The other distractors are all incorrect.

The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points?

"Gallstones have developed, which are typically composed of cholesterol." -Cholelithiasis or gallstones is caused by precipitation of substances contained in bile, mainly cholesterol and bilirubin. It is most common in women, multiple pregnancies, those taking oral contraceptives or those who are obese

The nurse is reviewing lab results of a client who has liver failure. The nurse determines that the client is at an increased risk for bleeding when the results include:

-increased prothrombin time Clients with liver failure have malabsorption of vitamin K (decrease), which impairs the synthesis of clotting factors. An increased prothrombin time places the client at risk for bleeding. Factors V, VII, IX, and X, prothrombin, and fibrinogen are synthesized by the liver; their decline in liver disease contribute to bleeding disorders. A decrease in RBC will not cause an increase in bleeding. An increased platelet count will cause the blood to clot.

When assessing the client with acute pancreatitis, which of these diagnostic tests, consistent with the disease, does the nurse anticipate will be altered?

Amylase and lipase -Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis.

When caring for the client with pancreatic cancer, for which of these signs and symptoms does the nurse assess?

Central abdominal pain, jaundice and weight loss -The clinical manifestations of pancreatic cancer depend on the size and location of the tumor as well as its metastasis. Pain, jaundice, and weight loss constitute the classic presentations. The most common pain is a dull epigastric pain often accompanied by back pain, often worse in the supine position, and relieved by sitting forward.

All diseases have risk factors. What is the most significant environmental risk factor for pancreatic cancer?

Cigarette smoking -In pancreatic cancer, the most significant and reproducible environmental risk factor is cigarette smoking. The other answers are incorrect.

A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which of the following treatments is most likely to be effective for her?

Corticosteroids and immunosuppressant drugs -This woman's hepatitis is probably caused by an autoimmune disorder rather than a virus. Lamivudine, peginterferon/ribavirin, and interferon alfa-2b are all antiviral agents. With autoimmune hepatitis, a chronic, usually progressive, inflammatory disease of the liver. Corticosteroids are the mainstay of treatment and have been shown to produce remission. Azathioprine, an immunosuppressant medication, is sometimes used along with prednisone. Using both medications may allow you to take a smaller dose of prednisone, reducing its side effects. Most people with this disease require long-term maintenance treatment

Ascites is an accumulation of fluid in the peritoneal cavity and usually occurs in advanced cirrhosis. What is the treatment of choice for ascites?

Diuretics -Because of the many limitations in sodium restriction, the use of diuretics has become the mainstay of treatment for ascites. A paracentesis may be done if the diuretics do not correct the problem. A thoracentesis would never be done for ascites. DDAVP is given to decrease urine output, not increase it.

A client newly diagnosed with pancreatic cancer is admitted to begin treatment. Which pain discriptors can be associated with adenocarcinomas of the pancreas?

Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward. -The most common pain [with pancreatic cancer] is a dull epigastric pain often accompanied by back pain, often worse in the supine position, and relieved by sitting forward. Sharp, stabbing pain with respirations could be pleurisy among other respiratory problems. Abdominal pain following a meal is usually assoicated with GERD or gastric ulcers. Cerebral edema causing headaches is not related to pancreatic cancer.

A client tells the nurse that he is concerned about developing hepatitis after being exposed to contaminated feces, saliva, and food. The nurse is aware that the client is at risk for:

Hepatitis A -Hepatitis A is normally transmitted through the fecal-oral route by drinking contaminated milk or water and eating shellfish from infected waters. Hepatitis B is transmitted through infected blood or serum, hepatitis C is transmitted by recreational injection drug use, and hepatitis D occurs largely to persons at high risk for HBV infection

The physician suspects a client may have developed pancreatitis, and the physician has ordered laboratory blood work. Diagnosis-confirming results would identify:

High serum amylase and lipase -Laboratory criteria for the diagnosis of pancreatitis are serum amylase or lipase greater than three times the upper limit of normal. Altered alkaline phosphatase and prothrombin level may indicate liver disease. Chymotrypsin digests proteins in the intestine.

When caring for the client with acute pancreatitis, which of these alterations does the nurse recognize is consistent with the disease?

Hyperglycemia -Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis. The white blood cell count may be increased, and hyperglycemia and an elevated serum bilirubin level may be present.

The health care provider has completed the assessment of a client who presented to the emergency department with jaundice. The provider determines that the jaundice is a result of:

Impaired uptake of bilirubin by the liver -The four major causes of jaundice are excessive destruction of RBCs, impaired uptake of bilirubin by the liver cells, decreased conjugation of bilirubin, and obstruction of the bowel flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts. Jaundice would not occur as a result of decreased oxygen. Jaundice in newborns is the result of the breakdown of fetal hemoglobin

When caring for the client with hepatic failure, the nurse recognizes which of these problems places the client at increased risk for bleeding?

Increased prothrombin time -An increased prothrombin time would increase the risk for bleeding. Other factors that contribute to increased bleeding risk in patients with liver failure is malabsorption of vitamin K (decrease), which further impairs the synthesis of clotting factors. Increased platelets would not cause increased bleeding but rather increase the risk of clotting, while red blood cell count is not relevant.

The liver has many jobs. One of the most important functions of the liver is to cleanse the portal blood of old and defective blood cells, bacteria in the bloodstream, and any foreign material. Which cells in the liver are capable of removing bacteria and foreign material from the portal blood?

Kupffer cells -Kupffer cells are reticuloendothelial cells that are capable of removing and phagocytizing old and defective blood cells, bacteria, and other foreign material from the portal blood as it flows through the sinusoid. Langerhans cells are stellate dendritic cells found mostly in the stratum spinosum of the epidermis. Epstein cells do not exist. Davidoff cells are large granular epithelial cells found in intestinal glands.

What laboratory markers are most commonly used to diagnose acute pancreatitis?

Lipase and amylase -Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis. Cholesterol and triglycerides are not used as laboratory markers for acute pancreatitis

A client is suspected of having the onset of alcoholic liver disease. The nurse should be assessing for which of the following manifestations related to the necrosis of liver cells?

Rapid onset of jaundice -Alcoholic hepatitis is the intermediate stage between fatty changes and cirrhosis and is characterized by inflammation and necrosis of liver cells. The condition is always serious and sometimes fatal. The cardinal sign of alcoholic hepatitis is rapid onset of jaundice. Hand tremors are not specific to alcoholic hepatitis. Long muscle group atrophy can occur but is not the primary sign. Development of nodules is not caused by alcoholic hepatitis.

The nurse is assessing a client who has just been admitted to the unit with a diagnosis of cholelithiasis. The nurse is aware that the client may manifest:

Right upper quadrant pain -The pain is usually located in the upper right quadrant or epigastric area and may be referred to the upper back, right shoulder, or midscapular region. Typically, the pain is abrupt in onset, increases steadily in intensity, persists for 2 to 8 hours, and is followed by soreness in the upper right quadrant.

When caring for a client with primary biliary cirrhosis, which of these statements by the nurse will best teach the client about the cause of this problem?

There is autoimmune destruction of the bile ducts. -Primary biliary cirrhosis (PBC) is a chronic disease of the liver characterized by the autoimmune destruction of intralobar bile ducts causing cholestasis; progressive scarring of the liver develops.

When assessing the client during the icteric phase of viral hepatitis, which of these findings does the nurse anticipate observing?

Yellow-tinged sclera -The icterus phase is reflected by development of jaundice of skin and sclera, liver tenderness and worsened prodromal symptoms

The nurse is assessing a client with acute pancreatitis who denies use of alcohol. When teaching the client about additional causes of acute pancreatitis, the nurse includes which of these in the discussion? Select all that apply.

• Gallstones • Increased cholesterol • Abdominal trauma -Acute pancreatitis is associated with alcohol abuse, gallstones, hyperlipidemia, hypercalcemia, infections (particularly viral), abdominal and surgical trauma, and drugs such as thiazide diuretics

An ultrasound (US) of a client with intermittent pain reveals gallbladder sludge. Which of the following client history items are likely factors in the US result? Select all that apply.

• Had lap band surgery 2 years ago and lost 100 pounds • Recent pregnancy with a 6-month-old child at home • Current prescription for a medicine to lower cholesterol. -Three factors contribute to the formation of gallstones: abnormalities in the composition of bile, stasis of bile (rather than rapid elimination), and inflammation of the gallbladder. The formation of cholesterol stones is associated with obesity and occurs more frequently in women, especially women who have had multiple pregnancies or who are taking oral contraceptives. All of these factors cause the liver to excrete more cholesterol into the bile. Estrogen reduces the synthesis of bile acid in women. Gallbladder sludge (thickened gallbladder mucoprotein with tiny trapped cholesterol crystals) is thought to be a precursor of gallstones. Sludge frequently occurs with pregnancy, starvation, and rapid weight loss. Drugs that lower serum cholesterol levels, such as clofibrate, also cause increased cholesterol excretion into the bile.