Med-Surg Ch.41

A patient who has a diagnosis of cirrhosis is at risk for development of infection. Which are reasons for potential development of infection? A. Adequate fluid volume is present. B. Cognitive changes are present in the late stage. C. The liver is no longer able to filter bacteria from the blood. D. The function of the spleen is impaired, which lowers resistance. E. Malnourishment causes the lack of nutrients needed to repair tissue.

C, D, E -Impairment of the liver and spleen as well as malnourishment will certainly affect the body's ability to fight infection.

What color would the nurse expect stool to be in a patient with a bile obstruction? A. Black B. Green C. Dark red D. Clay-colored

D -Clay-colored stool is characteristic of bile obstruction. Green stool may indicate extra bile, which would not occur with obstruction. Dark red stool may be caused by some food coloring, or a lower gastric bleed. Black stools are indicative of gastrointestinal bleeding or may be caused by iron supplements. p. 850

Which medication is used to prevent breakdown of ammonia in the intestines in a patient who has esophageal varices? A. Vitamin K B. Lactulose C. Propranolol D. Pantoprazole

B -Lactulose is a laxative agent used to promote elimination of ammonia in stool and to prevent or treat hepatic encephalopathy. Propranolol is a beta-adrenergic blocker used to reduce blood pressure in long-term management. Pantoprazole is a proton pump inhibitor. Vitamin K is used to manage serious bleeding disorders.

A patient is having blood drawn for suspected liver disease. The PT is 12, and the INR is 1. The laboratory has called the nurse with the results. What is the nurse's best action? Place the results in the chart. Call the care provider immediately. Prepare for assisting with a liver biopsy. Institute safety precautions due to increased risk for bleeding.

A -The PT of 11.0 to 12.6 seconds and the INR of 1 to 1.2 are within normal limits, so no further action is needed unless the care provider has specifically instructed to do so. The patient's results are not indicative of a prolonged clotting time or evidence of liver disease, therefore a liver biopsy may not be done. The results of the PT and INR do not demonstrate increased risk for bleeding. p. 853, Table 41-1

A patient who is diagnosed with acute pancreatitis is to receive propantheline bromide to assist with decreasing pancreatic enzyme secretion. Which nursing intervention by the nurse is appropriate when administering this medication? A. Administer the medication 30 minutes before a meal. B. Place the capsule in applesauce or fruit juice to mask the taste. C. Monitor the patient's blood glucose level before meals and at bedtime. D. Give the medication along with the ordered antacid to increase effectiveness.

A -This medication is more effective if administered 30 minutes prior to a meal or snack. There is no reason to mask the taste of this medication. Blood glucose is typically not affected by this medication. This medication must not be administered within 1 hour of an antacid or antidiarrheal as it interferes with absorption. p. 881, Table 41-6

The LPN is caring for a patient who is scheduled to undergo magnetic resonance imaging (MRI). Which is the most important instruction related to preparing the patient for this procedure? "You may feel claustrophobic." "MRI is painless and noninvasive." "You must lie still on the narrow surface." "You must remove all metal before the procedure."

D -Because the risk for significant injury to the patient exists, asking the patient to remove all metal before the procedure is the most important instructional point. After the nurse stressed the importance of removing all metal before the procedure, the nurse would inform the patient that he or she may feel claustrophobic, that the MRI is painless and noninvasive, and that he or she must lie still on the narrow surface. p. 854, Table 41-1

The nurse is providing discharge instructions that include education for a patient who was recently diagnosed with hepatitis B. Which information should be included in the teaching plan for this patient? The diet should be regular with added vitamin and mineral supplements. Activity levels will depend on the patient's signs and symptoms and liver function tests. Once the patient has completed an antiviral medication, he or she will no longer be contagious. It is important to take a medication such as diphenhydramine (Benadryl) around the clock to prevent severe itching.

B -Activity levels are dependent upon the individual patient's signs and symptoms. The diet for a patient who has hepatitis should be high-calorie, high-carbohydrate, moderate- to high-protein, and moderate- to low-fat with supplementary vitamins. Antiviral medications may help to lessen symptoms; however, the patient may still be contagious. Benadryl is helpful for itching when it occurs; however, there is no need to take it routinely. pp. 858-860

Which medication would be given to promote elimination of ammonia in fecal matter and to treat hepatic encephalopathy in a patient with cirrhosis? Furosemide Lactulose Propranolol Spironolactone

B. -Lactulose is used to help eliminate ammonia in feces and to prevent or treat hepatic encephalopathy. Furosemide is used for excretion of excess fluid. Propanolol reduces pressure in veins, decreasing the risk for bleeding. Spironolactone is used to decrease excess fluid. p. 863, Table 41-3

The nurse is reviewing the medical record for a newly admitted patient. Which finding best correlates with the presence of ascites mentioned in the record? A. Enlargement of the liver B. Golden-yellow skin color C. Fluid accumulation in the peritoneal cavity D. Enlargement of breast tissue in a male patient

C -Ascites is fluid accumulation in the peritoneal cavity. Hepatomegaly is liver enlargement. Jaundice is a golden-yellow skin color associated with liver dysfunction or bile obstruction. Gynecomastia is an enlargement of breast tissue in men.

Blood from the aorta is delivered to the liver via which structure? Portal vein Kupffer cells Hepatic artery Parenchymal cells

C -Blood from the aorta is delivered to the liver via the hepatic artery. The portal vein delivers blood from the intestines to the liver. Reticuloendothelial cells, called Kupffer cells, ingest old red blood cells and bacteria. Parenchymal cells carry out various metabolic functions, including metabolism of carbohydrates, fats, proteins, and steroids, and they detoxify potentially harmful substances. p. 848

The nurse is providing discharge instructions for a patient who had a laparoscopic cholecystectomy. Which instructions should be included? A. Avoid heavy lifting for the first 48 hours. B. Low-fat diet is recommended for 2 weeks. C. Remove the dressings and shower after 7 days. D. Sexual activity may be resumed when you feel well enough.

D -The patient recovering from a laparoscopic cholecystectomy should avoid heavy lifting for 4 to 6 weeks. The dressing may be removed and the patient may shower normally the day after surgery. Sexual activity may be resumed when the patient feels well enough. A low-fat diet is recommended for at least 4 to 6 weeks.

A patient who was recently diagnosed with chronic pancreatitis is discharged with a prescription for pancreatin pancrelipase. Which information should be included in the patient education instructions? Wipe the lips with a wet cloth to prevent skin irritation. Mix the medication in milk or ice cream to mask the taste. Take the medication on an empty stomach 1 hour prior to a meal. Capsule contents may be sprinkled on food but should not be chewed. Evaluate drug effectiveness by observing the number and consistency of stools.

Wiping the lips after administration prevents breakdown of the sensitive skin of the lips. Capsule contents may be sprinkled on food, but not chewed. The medication may be mixed in fruit juice or applesauce but should not be given with a protein substance such as milk or ice cream. The medication should be taken with a meal or snack in order for the enzymes to be effective. The stools will be frothy and bulky if the enzymes are inadequate. p. 882, Table 41-6

A patient is scheduled for a needle biopsy of the liver in the radiology department. What nursing interventions would the nurse identify as being a priority for this patient postprocedure? A. Position the patient on the right side. B. Palpate the abdomen for tenderness. C. Monitor for tachycardia and hypotension. D. Have blood drawn for coagulation profile. E. Maintain a pressure dressing over the site.

A, C, E

A patient had a cholecystectomy and now has a T-tube in place. Which finding warrants further action by the nurse? A. Drainage from the T-tube has turned to a greenish-brown color. B. The patient has tolerated the T-tube being clamped for an 8-hour period. C. The amount of drainage in the T-tube was 1100 mL during a 24-hour period. D. The amount of drainage from the T-tube has decreased to 150 mL in 24 hours.

C -The physician should be notified if drainage is more than 1000 mL in 24 hours.

The history and physical examination of a patient being admitted to a long-term care center indicates a diagnosis of alcoholic cirrhosis several years ago. The health care staff is aware that this type of cirrhosis is caused by which factor? A. Exposure to alcohol B. Obstruction of bile flow C. Complication of hepatitis D. Venous congestion and hypoxia

A -Alcoholic cirrhosis is caused by exposure to excessive amounts of alcohol. Biliary cirrhosis develops as a result of obstruction to bile flow. Postnecrotic cirrhosis can be a complication of hepatitis during which massive liver cell necrosis occurs. Cardiac cirrhosis develops after severe right-sided heart failure. Venous congestion and hypoxia lead to necrosis of liver cells. p. 850

When reading through a patient's history and physical report, a student nurse notices that the patient has frequent dyspepsia. While preparing research, the student notes that dyspepsia is a medical term with which meaning? Heartburn Constipation Shortness of breath Difficulty swallowing

A -Dyspepsia refers to heartburn. Constipation is the medical term for less frequent or absent bowel movements. Dyspnea is the term for shortness of breath. Dysphagia is the term for difficulty swallowing. p. 861

Which is the most appropriate Nursing Intervention while caring for a patient who underwent T-tube cholangiography? Providing a fatty meal Administering an antihistamine drug Maintaining strict bed rest for 8 hours Encouraging the patient to drink fluids

A -T-tube cholangiography is a test that is used to evaluate the bile ducts after gallbladder surgery. A fatty meal helps to eliminate the dye after the procedure and is the most appropriate intervention. An antihistamine drug is administered for allergic symptoms. A patient who underwent percutaneous transhepatic cholangiography, not T-tube cholangiography, requires strict bed rest for 8 hours. The nurse encourages the intake of fluids in the patient who has been injected with a radionuclide for a gallbladder scan or hepatobiliary imaging because the increased intake of fluid promotes the elimination of the radionuclide. p. 853, Table 41-1

A patient with cirrhosis of the liver is admitted to the hospital. Which patient symptoms are most closely associated with cirrhosis? . A. Pruritus B. Jaundice C. Enlarged testes D. Bruises and epistaxis E. Heaviness in the left upper abdominal quadrant

A, B, D -A patient with cirrhosis would likely have bruises and epistaxis due to thrombocytopenia and prothrombin deficiency. Jaundice is likely due to elevated serum bilirubin levels. Intense pruritus or itching results from the deposits of bile salts under the skin. The patient would have heaviness in the right upper abdominal quadrant. The testes tend to atrophy, not enlarge, with cirrhosis. pp. 860-861

A patient with cancer of the head of the pancreas is admitted to the hospital. Which patient symptoms are most closely associated with this diagnosis? . Jaundice Constipation Liver enlargement Upper abdominal pain Unexplained weight gain

A, C, D -A patient with pancreatic cancer frequently has symptoms of jaundice, upper abdominal pain, and liver enlargement. The patient usually has anorexia and unexplained weight loss. Diarrhea, not constipation, is a common symptom. pp. 884-885

The nurse learns in morning report that one patient has viral hepatitis. The nurse knows that which virus most likely caused the patient's hepatitis? A B C D

A. -Hepatitis A is the most common type of viral hepatitis. The incidence of hepatitis B has dramatically declined since the 1980s as a result of a comprehensive preventive program. Hepatitis C and D are not the most common types of viral hepatitis. p. 856

Percutaneous transhepatic cholangiography has been ordered for a patient. Which information must be communicated to other members of the health care team? A. Prothrombin time of 11.2 B. Allergy to clams and mussels C. Pulse of 76 and blood pressure of 128/74 D. Anaphylactic reaction to doxycycline (Vibrox)

B -Allergies to iodine or seafood must be reported before the test, as there may be an allergic reaction to the dye used. The information should be noted on an allergy band, chart, and communication to persons ordering and performing the test.

A nurse in a health clinic is providing education regarding risk factors associated with the development of pancreatic cancer. Which are considered risk factors of this disease? A. Obesity B. Cigarette smoking C. Intake of a high-fat diet D. History of hypertension E. Exposure to toxic chemicals

B, C, E -Risk factors for the development of cancer of the pancreas include having chronic pancreatitis, smoking, high-fat diet, African-American heritage, and exposure to toxic chemicals. There does not appear to be a correlation to pancreatic cancer in patients who are obese or who have hypertension.

The nurse is providing care for a patient following a cholecystectomy with T-tube placement. Which interventions regarding the T-tube should the nurse perform? A. Position patient in high Fowler position B. Cleanse area around the drain using aseptic technique C. Clamp T-tube 4 to 6 hours before a meal so bile will be available for digestion D.Assess drain for normal greenish-brown drainage immediately postoperatively E. Provide patient care instructions for how to care for T-tube if the patient is discharged with it

B, E

Which factors predispose a patient to disorders of the gallbladder? A.Male B.Fertile C.Obesity D.Sedentary E.Family history F.40 years of age

B-F -The age of 40 is one of the five factors used to describe persons at risk for gallbladder disorders. Obesity or being overweight is a factor, as is being fertile. A sedentary lifestyle is also a risk factor. Family history can show a tendency toward gallbladder issues. Being female is a greater risk factor than being male. p. 871

The nurse is caring for a patient in the icteric phase of hepatitis and knows that which symptoms will most likely be seen?

Jaundice, light- or clay-colored stools, and dark urine

The nurse is assisting with data collection on a patient with cholecystitis. On the provided figure, what anatomic areas would the nurse expect the patient to identify when the patient is asked to locate the pain?

RUQ & Shoulder -Pain can vary; however, cholecystitis pain is mostly identified as being in the right upper quadrant where the gallbladder is located and will also radiate to the right shoulder. #3 isolates the liver area; #4 isolates the area of the transverse colon. p. 849

The nurse is caring for a patient who is suspected of having acute pancreatitis. Which is the most important diagnostic finding in acute pancreatitis? Elevated lipid levels Elevated glucose levels Elevated serum amylase Elevated white blood cell count

C -Although each of these laboratory values may be elevated with a diagnosis of acute pancreatitis, elevated serum amylase along with serum lipase and urinary amylase levels are the most important diagnostic finding. pp. 879-880

A patient returns to the nursing unit after a liver biopsy. The nurse should immediately place the patient in which position? Prone Supine Semi-Fowler Right side-lying

D -After a liver biopsy, the patient is kept on the right side for at least 2 hours to maintain pressure on the puncture site. After being allowed to change positions, the patient may still be kept in a supine position for up to 14 hours. The prone and semi-Fowler positions are not appropriate for a patient immediately after a liver biopsy. pp. 855-856

The nurse is assisting with data collection on a patient who has been diagnosed with the early stage of cirrhosis. Which sign or symptom is usually seen in the early stages of this disease?

Dull heaviness in the right upper quadrant of the abdomen

The nurse is caring for a patient who recently received a liver transplant. Patient education instructions include information regarding how to monitor for signs of rejection. Which is sometimes the only sign of rejection? Fever Anorexia Muscle aches Abdominal pain

A -Signs of rejection may include fever, anorexia, depression, vague abdominal pain, muscle aches, and joint pain. Sometimes the only sign of rejection is fever; therefore the patient must carefully monitor vital signs after discharge. pp. 869-870

While assisting with data collection for a patient with suspected liver disease, which findings would be of concern? Pruritus Scleral icterus Palmar erythema Nondistended abdomen Practices the Mormon religion Liver palpable under right rib cage

A, B, C, F -Pruritus is the itching caused by a buildup of toxins associated with liver disease. This would be determined by the patient complaining of itching or presenting with scratch marks during physical assessment. Scleral icterus is a yellowing of the eyes associated with liver disease or bile obstruction. Palmar erythema is redness of the palms associated with liver disease or excess hormones. A nondistended abdomen is a normal finding. Alcohol consumption is prohibited in the Mormon religion, making it unlikely that the patient would be imbibing. Unless the liver is enlarged, it should not be palpable. p. 851

The nurse is caring for a patient who was admitted with severe nausea and vomiting as a complication of hepatitis A. Which interventions by the nurse are appropriate for this patient? Apply a cool damp cloth to the face and neck. Remove the emesis basin as soon as the patient vomits. Administer an oral antiemetic as ordered by the health care provider. Measure the amount and characteristic of any vomitus and document. Have dietary deliver a meal tray at the regular times in case the patient wants to eat.

A, B, D -Comfort measures for this patient would include a cool damp cloth applied to the face and neck. Removing the emesis basin is important so that the patient does not become more nauseated with it in the room. It is important to measure output of vomitus to detect early intake and output imbalances. The nurse should consult with the health care provider regarding a route of antiemetic that is not oral. Dietary should hold trays until the patient is feeling less nauseated, as food in the room may create an unpleasant experience. p. 859

A patient who was recently diagnosed with cirrhosis reports to the nurse a decrease in appetite. Which interventions by the nurse would be appropriate for this patient? Encourage the patient to eat small amounts even when not hungry. Arrange a dietary consult for the patient to report likes and dislikes. Alcohol taken in small amounts may act as a stimulant to the appetite. Eating one large meal daily and supplementing with snacks may help appetite. Make mealtimes as pleasant as possible with emesis basins and bedpans out of sight. Omit foods that are known to cause gastrointestinal upsets or that are not appetizing to the patient.

A, B, E, F -Sometimes small amounts of food can stimulate the appetite, even when the patient is not hungry. A dietary consult will help plan delivery of foods that the patient enjoys. Omission of foods known to create discomfort is important. Eating smaller more frequent meals may be more acceptable. Alcohol, even in small amounts, is discouraged due to toxic effects on the liver. p. 867

A nurse is providing care for a patient who has been diagnosed with acute pancreatitis. In addition to nausea and vomiting, what other signs and symptoms may this patient be experiencing? Elevation of the heart rate Decrease of the respiratory rate Pain in the right lower abdomen Low-grade fever and restlessness Epigastric discomfort radiating to the back Hyperactive bowel sounds in all quadrants

A, D, E -Acute pancreatitis may result in left upper-quadrant pain or epigastric pain that radiates to the back. The heart rate and respiratory rate will both be elevated. A low-grade fever and restlessness are common. The abdomen may be tender with absent bowel sounds, which may indicate an ileus. pp. 879-880

The licensed practical nurse (LPN) is caring for a patient with hepatic encephalopathy who is being treated with neomycin sulfate. Which is the priority instruction that the nurse should give related to this medication? A.Report any changes in gastrointestinal function. B.Report any ringing in the ears or loss of balance. C.Report frequent episodes of nausea and vomiting. D.Take the medication as ordered by this health care provider.

B -The patient should immediately report symptoms of ringing in the ears or loss of balance because these signs are indicative of toxicity. Although reporting changes in gastrointestinal function and taking the medication as ordered are important, these are not the priority instructions. While the patient may experience nausea, the patient is not likely to experience vomiting associated with this medication. p. 863, Table 41-3

The nurse is providing instructions for a patient who will be having a percutaneous transhepatic cholangiography in 2 days. Which statement by the patient indicates understanding of this procedure? A. "I will be able to leave the facility as soon as the procedure is finished." B. "The nurses will monitor me for dye allergies and I will eat a fatty meal to eliminate the dye." C. "This procedure requires that I be on bed rest for a minimum of 12 hours afterward." D. "Results of the test will be discussed with my family while I am recovering from the procedure."

B -The percutaneous transhepatic cholangiography is an invasive procedure performed while a needle is inserted into the liver and dye injected. The nurse must closely monitor the puncture site for bleeding and must also monitor vital signs frequently. The nurses will monitor the patient for dye allergies and will provide a fatty meal to help eliminate the dye. The patient will be maintained on bed rest for a minimum of 8 hours and will stay at the facility while this is accomplished. The results of the test will be discussed with the patient after the procedure.

The nurse is providing instructions to a certified nursing assistant (CNA) regarding care for a patient who has hepatitis. Due to extreme fatigue, the patient will be on bed rest. Which interventions are appropriate? Maintain bed rest, and turn the patient every 4 hours. Assist the patient to cough and deep-breathe at least every 2 hours. Apply moisturizing lotion to the skin to assist with protection and itching. Gently massage the lower extremities occasionally to increase circulation. Promote rest by planning activities to allow times when the patient is not disturbed.

B, C, E -Coughing and deep breathing every two hours will help prevent respiratory complications. Applying lotion to the skin will assist with dryness and itching. Planning activities to allow periods of rest are important in the recovery process. If bed rest is maintained, the patient should be turned at least every 2 hours. Massaging of the extremities is discouraged so that any clots that may have formed will not be dislodged. pp. 858-860

A college student presents to the university health services department with sudden onset of flulike symptoms. The nurse practitioner does a physical exam and orders laboratory work. When the health nurse reviews the laboratory work, which elevated level would suggest a possible liver disorder? Prothrombin time (PT) Blood urea nitrogen (BUN) Alanine aminotransferase (ALT) Carcinoembryonic antigen (CEA)

C -Alanine aminotransferase (ALT) detects elevation in enzymes related to liver disease. Prothrombin time (PT) can be prolonged in liver disease but can also be prolonged with anticoagulation disorders and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or anticoagulation medications. BUN reflects kidney function and hydration status. Carcinoembryonic antigen (CEA) increases with many types of cancer. pp. 853, Table 41-1, 858

The LPN is caring for a patient who has undergone a liver biopsy. Which should be the nurse's priority action after the patient has completed the procedure? A. Maintain the patient on bed rest. B. Maintain the patient on the right side. C. Check the pressure dressing for bleeding. D. Reinforce the pressure dressing as needed.

C -Although all of the nursing actions are important and should be implemented at some point postprocedurally, checking the pressure dressing for bleeding is the first intervention that the nurse would implement after the test. Keeping the patient on the right side maintains the pressure on the puncture site. Bed rest may be maintained even after the patient is allowed to turn off of the right side. The nurse should also reinforce the pressure dressing as needed, but only after checking the pressure dressing for bleeding. pp. 855-856

The LPN is caring for a patient who is scheduled to undergo abdominal ultrasonography. Which is the priority preprocedural instruction that the nurse should give? A. "You will be lying on a table during the procedure." B. "You will feel a technician apply gel to the abdomen." C. "Take nothing by mouth for 8 to 12 hours before the test." D. "You can see images projected onto a screen during the test."

C -Asking the patient to avoid taking anything by mouth for 8 to 12 hours before the test is the most important preprocedural instruction for the patient. If this status is not maintained, the test cannot take place. After this instruction is given, the nurse can inform the patient that he or she will be lying on a table during the procedure, feel a technician apply gel to the abdomen, and see images projected onto a screen during the test.

The nurse is preparing to assist with data collection at the start of a shift on a patient who was diagnosed with cholecystitis. Based on a knowledge of cholecystitis, the nurse would expect the patient to complain of pain in which quadrant? Left lower Left upper Right upper Right lower

C -Pain of cholecystitis is located in the right upper quadrant and radiates to the shoulder. Patients with appendicitis often complain of pain in the right lower quadrant. Cholecystitis does not cause pain in the left lower or left upper quadrants. pp. 871-872

The student nurse is studying the clotting cascade and recognizes that clotting cannot occur without which two essential elements? Fats and protein Albumin and globulin Prothrombin and fibrinogen Aldosterone and prothrombin

C -Two essential elements for coagulation, prothrombin and fibrinogen, are synthesized by the liver. Fats and protein are broken down in response to low blood glucose levels, and molecules are used to make more glucose. Some nonessential amino acids, plasma proteins (albumin and globulin), and clotting factors are synthesized in the liver. The liver plays an important role in the metabolism of adrenocortical hormones, estrogen, testosterone, and aldosterone. If these hormones are not metabolized, they accumulate, which causes an exaggerated effect on target organs. p. 850

The nurse is assigned to observe a patient immediately after a needle biopsy of the liver is performed. Which nursing action would be most appropriate? Monitor vital signs every 15 minutes for 1 hour, and then hourly. Position the patient on the left side. Monitor vital signs every 30 minutes for 2 hours, and then hourly. Position the patient in the right side-lying position. Monitor vital signs every 15 minutes four times, and then every 30 minutes two times. Position the patient on the right side. Monitor vital signs every 15 minutes for 1 hour, followed by every 30 minutes for the next hour. Position the patient on the left side.

C -Vital signs should be monitored every 15 minutes for the first hour, then every 30 minutes for the next hour, and then hourly. While assessing vital signs, the pressure dressing should be assessed for bleeding. The patient is placed on the right side for at least 2 hours. The patient would be placed on the right side rather than the left side to maintain pressure on the puncture site. p. 855

A patient with newly diagnosed hepatitis B infection asks the nurse how he could have been infected with this virus. What risk factors would the nurse identify? A. Patient drank contaminated water. B. There is a family history of the disorder. C. Patient had a recent surgical procedure. D. Patient had intimate contact with a carrier of the virus. E. Patient shook hands with a person who had hepatitis B.

C,D -Modes of transmission of hepatitis B include contaminated medical equipment and intimate contact with carriers. Hepatitis A is found in contaminated water, not hepatitis B. Casual contact will not spread the virus; transmission is by exposure to blood and other body fluids. p. 856

The LPN is caring for a patient who has been diagnosed with cholelithiasis. The nurse is contributing to the discharge plan for the patient. Which priority discharge instruction would the nurse give the patient? Maintain a low-fat diet supplemented with fat-soluble vitamins. Keep appointments to have blood drawn for liver function tests. Use a second form of birth control other than oral contraceptives. Report experiencing light stools, dark urine, jaundice, and itching.

D -Although all of the instructions are important, reporting light stools, dark urine, jaundice, and itching is the most important instruction because these symptoms are indicative of bile duct obstruction. The patient should also be instructed to maintain a low-fat diet supplemented with fat-soluble vitamins, keep appointments to have blood drawn for liver function tests, and use a second form of birth control other than oral contraceptives, but these instructions are not the most important. p. 875

The nurse is caring for a patient who has been recently diagnosed with hepatitis B. While assisting with data collection on this patient, the nurse may expect to observe which signs or symptoms of hepatitis B? Light-colored urine Dark-colored urine Dark-colored stools Enlarged lymph nodes Left upper-quadrant pain Right upper-quadrant pain

D -Patients who have been diagnosed with hepatitis B may have dark-colored urine and light-colored stools as a result of impaired bile production and secretions. Pain is usually located in the right upper quadrant where the liver is located. Many patients experience enlarged lymph nodes. p. 856

A patient has a T-tube in place 1 day after a cholecystectomy. Which is the best description of the expected drainage from the T-tube? Bloody Purulent Yellow brown Greenish brown

D -When a patient first returns from a cholecystectomy, the drainage from the T-tube may be bloody, but it should soon become greenish brown. If the drainage is bloody or purulent, the nurse would notify the health care provider immediately. Yellow brown drainage is not an expected finding. p. 873