MED SURG EAQ CH. 41

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? 1. A 2. B 3. C 4. D

1. 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.

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? 1. Administer the medication 30 minutes before a meal. 2. Place the capsule in applesauce or fruit juice to mask the taste. 3. Monitor the patient's blood glucose level before meals and at bedtime. 4. Give the medication along with the ordered antacid to increase effectiveness.

1. Administer the medication 30 minutes before a meal. 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.

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? 1. Fever 2. Anorexia 3. Muscle aches 4. Abdominal pain

1. Fever 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.

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? Select all that apply. 1. Apply a cool damp cloth to the face and neck. 2. Remove the emesis basin as soon as the patient vomits. 3. Administer an oral antiemetic as ordered by the health care provider. 4. Measure the amount and characteristic of any vomitus and document. 5. Have dietary deliver a meal tray at the regular times in case the patient wants to eat.

1. Apply a cool damp cloth to the face and neck. 2. Remove the emesis basin as soon as the patient vomits. 4. Measure the amount and characteristic of any vomitus and document. 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.

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? Select all that apply. 1. Elevation of the heart rate 2. Decrease of the respiratory rate 3. Pain in the right lower abdomen 4. Low-grade fever and restlessness 5. Epigastric discomfort radiating to the back 6. Hyperactive bowel sounds in all quadrants

1. Elevation of the heart rate 4. Low-grade fever and restlessness 5. Epigastric discomfort radiating to the back 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.

The nurse knows that which are the functions of bile? Select all that apply. 1. Emulsifies fat 2. Removes some toxins 3. Neutralizes alkalytic chime 4. Helps absorb fat-soluble vitamins 5. Converts urobilinogen to bilirubin 6. Produced in the gallbladder, aids the liver

1. Emulsifies fat 2. Removes some toxins 4. Helps absorb fat-soluble vitamins Bile emulsifies fat, breaking it into small particles that can be absorbed. Bile is responsible for removing some toxins. In addition, bile plays a role in the absorption of fat-soluble vitamins. Bile neutralizes acidic rather than alkalytic chime as it leaves the stomach. In the large intestine, bile is converted to urobilinogen and then stercobilin, not bilirubin. Bile is produced in the liver and stored in the gallbladder.

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? Select all that apply. 1. Encourage the patient to eat small amounts even when not hungry. 2. Arrange a dietary consult for the patient to report likes and dislikes. 3. Alcohol taken in small amounts may act as a stimulant to the appetite. 4. Eating one large meal daily and supplementing with snacks may help appetite. 5. Make mealtimes as pleasant as possible with emesis basins and bedpans out of sight. 6. Omit foods that are known to cause gastrointestinal upsets or that are not appetizing to the patient.

1. Encourage the patient to eat small amounts even when not hungry. 2. Arrange a dietary consult for the patient to report likes and dislikes. 5. Make mealtimes as pleasant as possible with emesis basins and bedpans out of sight. 6. Omit foods that are known to cause gastrointestinal upsets or that are not appetizing to the patient. 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.

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? 1. Exposure to alcohol 2. Obstruction of bile flow 3. Complication of hepatitis 4. Venous congestion and hypoxia

1. Exposure to alcohol 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.

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? 1. Heartburn 2. Constipation 3. Shortness of breath 4. Difficulty swallowing

1. Heartburn 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.

A nurse is leading an education class on the various types of hepatitis for newly hired certified nurse assistants (CNAs). Which statement best describes hepatitis A? 1. Infectious hepatitis is the most common type and is rarely fatal. 2. Serum hepatitis is found in body fluids and is of particular concern to health care workers. 3. This type of hepatitis is most likely to result in the person becoming a chronic carrier of the virus. 4. Chronic forms of this type do not exist and are considered to be very rare in the United States.

1. Infectious hepatitis is the most common type and is rarely fatal. Hepatitis A is called infectious or epidemic and is transmitted from one person to another through contaminated food, water, or medical equipment. It is the most common type and is rarely fatal. Serum hepatitis is also known as hepatitis B and is found in body fluids and medical equipment that is contaminated. Persons with hepatitis C are more likely to become chronic carriers of the virus. Hepatitis E is similar to hepatitis A; however it is rarely seen in the United States.

The blood work of a patient with acute pancreatitis shows a decrease in the amylase level from 230 units/L to 158 units/L. How would the nurse interpret this data? 1. Inflammation has decreased. 2. Bile production has decreased. 3. Risk for bleeding has decreased. 4. Pancreatic enzymes are deficient.

1. Inflammation has decreased. Amylase level is indicative of pancreatitis, which is an inflammation of the pancreas, and the blood level will reduce when the inflammation subsides. Bile is not produced by the pancreas. Risk for bleeding is associated with liver disease, not pancreatic diseases; pancreatic enzymes are within normal limits and are therefore not deficient.

The nurse is providing care for a patient who was diagnosed with liver failure. Which treatments and nursing interventions would the nurse expect to provide for this patient? Select all that apply. 1. Liquid or small semisolid meals 2. Supplementary iron and vitamins 3. Ambulate with assistance three times each day 4. Increased amounts of fluid to prevent dehydration 5. Prescription medications including cathartics and antibiotics

1. Liquid or small semisolid meals 2. Supplementary iron and vitamins 5. Prescription medications including cathartics and antibiotics Liquid or small semisolid meals are more easily tolerated when anorexia is present. Supplementary iron and vitamins are necessary to prevent deficiencies. Medications such as cathartics and antibiotics are typically ordered to prevent hepatic encephalopathy. Ambulation is contraindicated; this patient needs to be on bed rest in order to allow the liver to regenerate and rest. Fluids are typically restricted in patients with liver failure, as there may be a problem with fluid retention.

The nurse is caring for a patient who was admitted with severe right upper-quadrant abdominal pain. A diagnosis of cholelithiasis is suspected. Which other signs and symptoms might this patient be experiencing? Select all that apply. 1. Pain radiating to the shoulder 2. Dark amber-colored urine output 3. Infrequent, dark-colored, painful bowel movements 4. Discomfort triggered by a meal high in carbohydrates 5. Gums bleed easily and multiple areas of bruising over the body

1. Pain radiating to the shoulder 2. Dark amber-colored urine output 5. Gums bleed easily and multiple areas of bruising over the body Right upper-quadrant abdominal pain radiating to the shoulder is commonly seen. Dark amber-colored urine is a result of bile flow being obstructed. Discomfort is usually seen about 3 hours after ingesting a high-fat meal. Easy bruising and bleeding is common if the vitamin K level is deficient. Bowel movements may be foul-smelling and fat-containing as a result of impaired digestion of fat, but they are not typically painful.

Which is the most appropriate Nursing Intervention while caring for a patient who underwent T-tube cholangiography? 1. Providing a fatty meal 2. Administering an antihistamine drug 3. Maintaining strict bed rest for 8 hours 4. Encouraging the patient to drink fluids

1. Providing a fatty meal 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.

A patient with cirrhosis of the liver is admitted to the hospital. Which patient symptoms are most closely associated with cirrhosis? (Select all that apply.) 1. Pruritus 2. Jaundice 3. Enlarged testes 4. Bruises and epistaxis 5. Heaviness in the left upper abdominal quadrant

1. Pruritus 2. Jaundice 4. Bruises and epistaxis 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.

A patient with cirrhosis of the liver is admitted to the hospital. Which patient symptoms are most closely associated with cirrhosis? Select all that apply. 1. Pruritus 2. Jaundice 3. Enlarged testes 4. Bruises and epistaxis 5. Heaviness in the left upper abdominal quadrant

1. Pruritus 2. Jaundice 4. Bruises and epistaxis 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.

A patient is advised to undergo laparoscopic cholecystectomy. The patient asks the nurse what exactly this procedure means. What are the points that a nurse can include in this explanation? (Select all that apply.) 1. The gallbladder is removed through small punctures on the abdominal wall. 2. The gallbladder is removed through an incision made on the right subcostal region. 3. The procedure is done with a laparoscope and grasping forceps under anesthesia. 4. The patient can be discharged on the day of operation or the next and resume work after a week. 5. The gallbladder is removed through an incision on the abdomen, and a catheter is inserted to drain any fluids or effusion.

1. The gallbladder is removed through small punctures on the abdominal wall 3. The procedure is done with a laparoscope and grasping forceps under anesthesia. 4. The patient can be discharged on the day of operation or the next and resume work after a week. Laparoscopic cholecystectomy involves making small punctures on the abdominal wall, and the gallbladder is removed using laparoscope and grasping forceps. This procedure is done under anesthesia. The patient can be discharged in a day or two, and resume regular activities in 3-7 days. This procedure does not involve incisions.

A patient is advised to undergo laparoscopic cholecystectomy. The patient asks the nurse what exactly this procedure means. What are the points that a nurse can include in this explanation? Select all that apply. 1. The gallbladder is removed through small punctures on the abdominal wall. 2. The gallbladder is removed through an incision made on the right subcostal region. 3. The procedure is done with a laparoscope and grasping forceps under anesthesia. 4. The patient can be discharged on the day of operation or the next and resume work after a week. 5. The gallbladder is removed through an incision on the abdomen, and a catheter is inserted to drain any fluids or effusion.

1. The gallbladder is removed through small punctures on the abdominal wall. 3. The procedure is done with a laparoscope and grasping forceps under anesthesia. 4. The patient can be discharged on the day of operation or the next and resume work after a week. Laparoscopic cholecystectomy involves making small punctures on the abdominal wall, and the gallbladder is removed using laparoscope and grasping forceps. This procedure is done under anesthesia. The patient can be discharged in a day or two, and resume regular activities in 3-7 days. This procedure does not involve incisions.

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? 1. The diet should be regular with added vitamin and mineral supplements. 2. Activity levels will depend on the patient's signs and symptoms and liver function tests. 3. Once the patient has completed an antiviral medication, he or she will no longer be contagious. 4. It is important to take a medication such as diphenhydramine (Benadryl) around the clock to prevent severe itching.

2. Activity levels will depend on the patient's signs and symptoms and liver function tests. 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.

Percutaneous transhepatic cholangiography has been ordered for a patient. Which information must be communicated to other members of the health care team? 1. Prothrombin time of 11.2 2. Allergy to clams and mussels 3. Pulse of 76 and blood pressure of 128/74 4. Anaphylactic reaction to doxycycline (Vibrox)

2. Allergy to clams and mussels 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 prothrombin time of 11.2 is within normal limits. A pulse of 76 and a blood pressure of 128/74 are within normal limits and should be compared against other vital signs to establish a baseline prior to the test. An anaphylactic reaction to doxycycline warrants an allergy bracelet and documentation, but it would not make the procedure unsafe.

A patient who has cirrhosis may have an impairment of the liver's ability to manufacture albumin. Which sign or symptom would be the result of impaired albumin? 1. Varices 2. Ascites 3. Jaundice 4. Neuropathy

2. Ascites A varices is a distended vessel that may be the result of increased pressure. Jaundice is a result of increased serum bilirubin levels. Neuropathy is thought to be a result of dietary deficiencies. Ascites is a result of low serum albumin levels causing water to leak into the capillaries, resulting in decreased blood volume and edema. Ascites is an accumulation of fluid in the peritoneal cavity.

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? Select all that apply. 1. Maintain bed rest, and turn the patient every 4 hours. 2. Assist the patient to cough and deep-breathe at least every 2 hours. 3. Apply moisturizing lotion to the skin to assist with protection and itching. 4. Gently massage the lower extremities occasionally to increase circulation. 5. Promote rest by planning activities to allow times when the patient is not disturbed.

2. Assist the patient to cough and deep-breathe at least every 2 hours. 3. Apply moisturizing lotion to the skin to assist with protection and itching. 5. Promote rest by planning activities to allow times when the patient is not disturbed. 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.

The nurse is caring for a patient who is returning to the unit following a liver biopsy. Which intervention implemented by the nurse is appropriate during the postintervention care of this patient? 1. Maintain the patient on the left side for at least 2 hours following the procedure. 2. Check vital signs every 15 minutes for the first hour, and then according to protocol. 3. Encourage the patient to keep the right arm above the head and to take frequent deep breaths. 4. Change the pressure dressing every 30 minutes for the first 2 hours, and assess the puncture site.

2. Check vital signs every 15 minutes for the first hour, and then according to protocol. To monitor for potential complications following a liver biopsy, vital signs are checked every 15 minutes for the first hour and then according to protocol. The patient must remain on the right side for at least 2 hours to maintain pressure on the puncture site. The patient is encouraged to keep the right arm above the head and to take frequent deep breaths during the actual procedure, not postprocedure. The pressure dressing should be checked for bleeding every 15 minutes for the first hour and then every 30 minutes during the second hour; however the dressing should not be removed or changed.

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? (Select all that apply.) 1. Obesity 2. Cigarette smoking 3. Intake of a high-fat diet 4. History of hypertension 5. Exposure to toxic chemicals

2. Cigarette smoking 3. Intake of a high-fat diet 5. Exposure to toxic chemicals 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.

A nurse is admitting a patient with a new diagnosis of cholecystitis and cholelithiasis. The patient asks the nurse for information about the disorder. Which information would the nurse include in the patient teaching? Select all that apply. 1. Males are most often affected. 2. Familial tendency is a risk factor. 3. Pain can occur after a fatty meal. 4. A high-fiber diet is recommended. 5. Belching and indigestion are common.

2. Familial tendency is a risk factor. 3. Pain can occur after a fatty meal. 5. Belching and indigestion are common. Fat ingestion causes the gallbladder to contract to release bile to aid digestion in the small intestine. In the presence of inflammation and stones, bile output is impaired causing more inflammation and the spasms associated with biliary colic. A high-fiber diet is ordered for patients with diverticulosis and has no effect on gallstones; females have a higher incidence related to pregnancy and hormonal influences. Familial tendency is a risk factor for gallbladder disease.

Which factors predispose a patient to disorders of the gallbladder? Select all that apply. 1. Male 2. Fertile 3. Obesity 4. Sedentary 5. Family history 6. 40 years of age

2. Fertile 3. Obesity 4. Sedentary 5. Family history 6. 40 years of age 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.

Which form of hepatitis is found in all body fluids of infected carriers and can be transmitted from an infected mother to her baby? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

2. Hepatitis B Hepatitis B, also known as serum hepatitis, is transferred via body fluids. Health care workers, children, and high-risk patients can receive a vaccination. Hepatitis A is transmitted via water, food, or medical equipment contaminated with fecal matter. Hepatitis C can be transmitted by infected blood or contaminated equipment, but there currently is no vaccine. Hepatitis D is a virus that is transmitted through the skin or mucous membranes. Hepatitis G is a virus that can be transmitted through blood transfusion.

Which medication is used to prevent breakdown of ammonia in the intestines in a patient who has esophageal varices? 1. Vitamin K 2. Lactulose 3. Propranolol 4. Pantoprazole

2. Lactulose 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.

Which medication would be given to promote elimination of ammonia in fecal matter and to treat hepatic encephalopathy in a patient with cirrhosis? 1. Furosemide 2. Lactulose 3. Propranolol 4. Spironolactone

2. Lactulose 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.

A patient with jaundice has developed pruritus. When planning care, which nursing intervention would be included to promote comfort? 1. Reposition every 2 hours. 2. Use mild soap if tolerated. 3. Provide a daily warm bath. 4. Encourage frequent mouth care.

2. Use mild soap if tolerated. Nursing care is aimed at reducing dryness and irritation. A warm bath would increase blood flow to the skin and increase itching; mouth care and repositioning have no effect on pruritus since it is caused by a buildup of bile salts in the skin.

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? 1. Prothrombin time (PT) 2. Blood urea nitrogen (BUN) 3. Alanine aminotransferase (ALT) 4. Carcinoembryonic antigen (CEA)

3. Alanine aminotransferase (ALT) 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.

The nurse is caring for a patient who is suspected of having acute pancreatitis. Which is the most important diagnostic finding in acute pancreatitis? 1. Elevated lipid levels 2. Elevated glucose levels 3. Elevated serum amylase 4. Elevated white blood cell count

3. Elevated serum amylase 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.

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? 1. Light-colored urine 2. Dark-colored stools 3. Enlarged lymph nodes 4. Left upper-quadrant pain 5. Right upper-quadrant pain

3. Enlarged lymph nodes 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.

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? 1. Enlargement of the liver 2. Golden-yellow skin color 3. Fluid accumulation in the peritoneal cavity 4. Enlargement of breast tissue in a male patient

3. Fluid accumulation in the peritoneal cavity 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.

A patient who has been diagnosed with late-stage cirrhosis is experiencing signs and symptoms related to the inability to metabolize bodily hormones. Which signs or symptoms would the nurse expect to observe in this patient as a result of interference in body hormone metabolism? Select all that apply. 1. Anemia 2. Jaundice 3. Gynecomastia 4. Spider angioma 5. Palmar erythema 6. Testicular atrophy

3. Gynecomastia 4. Spider angioma 5. Palmar erythema 6. Testicular atrophy Gynecomastia, spider angioma, palmar erythema, and testicular atrophy all result as the liver is unable to metabolize testosterone, aldosterone, and adrenocortical hormones. Anemia is a result of prothrombin deficiency, and jaundice is a result of elevated serum bilirubin levels.

Blood from the aorta is delivered to the liver via which structure? 1. Portal vein 2. Kupffer cells 3. Hepatic artery 4. Parenchymal cells

3. Hepatic artery 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.

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? 1. Monitor vital signs every 15 minutes for 1 hour, and then hourly. Position the patient on the left side. 2. Monitor vital signs every 30 minutes for 2 hours, and then hourly. Position the patient in the right side-lying position. 3. Monitor vital signs every 15 minutes four times, and then every 30 minutes two times. Position the patient on the right side. 4. 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.

3. Monitor vital signs every 15 minutes four times, and then every 30 minutes two times. Position the patient on the right side. 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.

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? Select all that apply. 1. Patient drank contaminated water. 2. There is a family history of the disorder. 3. Patient had a recent surgical procedure. 4. Patient had intimate contact with a carrier of the virus. 5. Patient shook hands with a person who had hepatitis B.

3. Patient had a recent surgical procedure. 4. Patient had intimate contact with a carrier of the virus. 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

The student nurse is studying the clotting cascade and recognizes that clotting cannot occur without which two essential elements? 1. Fats and protein 2. Albumin and globulin 3. Prothrombin and fibrinogen 4. Aldosterone and prothrombin

3. Prothrombin and fibrinogen 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.

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? 1. Left lower 2. Left upper 3. Right upper 4. Right lower

3. Right upper 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.

A nurse is assisting with data collection on a female patient who is being seen at the clinic for possible gallbladder disease. Which patient finding would the nurse document as being highly suspicious for a patient who is developing gallbladder disease? 1. She follows a low fat diet. 2. Patient had a recent tattoo. 3. She is 2 weeks postpartum. 4. Patient received a flu shot last week.

3. She is 2 weeks postpartum. Childbearing women are at risk for gallbladder disease. A low-fat diet is therapeutic for treating gallbladder disease but does not cause the disease. A recent tattoo would be a risk factor for hepatitis B. Receiving a flu shot does not increase the risk for developing gallbladder disease.

A patient suffering from cholelithiasis underwent a laparoscopic cholecystectomy. Which discharge instruction will the nurse give this patient? 1. Limit fluid intake 2. Leave the dressings on for one week 3. Empty the T tube several times a day. 4. Avoid or keep fats to the minimum for several weeks.

4. Avoid or keep fats to the minimum for several weeks. The patient is instructed to eat a low-fat diet for several weeks after cholecystectomy. The dressings are removed the day after surgery. It is not recommended to limit food intake. A T tube is not generally inserted with a laparoscopic cholecystectomy.

What color would the nurse expect stool to be in a patient with a bile obstruction? 1. Black 2. Green 3. Dark red 4. Clay-colored

4. Clay-colored 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.

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? 1. Esophageal varices 2. Jaundice of the skin 3. Excess ammonia levels in the blood 4. Dull heaviness in the right upper quadrant of the abdomen

4. Dull heaviness in the right upper quadrant of the abdomen Slight weight loss, unexplained fever, fatigue, and dull heaviness in the right upper quadrant are typically seen in the early stage of cirrhosis. Esophageal varices and hemorrhoids related to increased pressure in the gastrointestinal tract is seen with progression of the disease. Jaundice of the skin is a later sign and is a result of elevated serum bilirubin levels. In the later stages of cirrhosis, the liver fails to metabolize ammonia and it builds up in the bloodstream.

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? 1. Bloody 2. Purulent 3. Yellow brown 4. Greenish brown

4. Greenish brown 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.

A patient who was diagnosed with cholelithiasis reports right-sided abdominal pain and nausea. Upon assessment, the patient states that the pain is a 6 on a 0 to 10 pain scale. Which medication would the nurse expect to administer for the patient's pain? 1. Ibuprofen 2. Promethazine 3. Morphine sulfate 4. Hydromorphone hydrochloride

4. Hydromorphone hydrochloride Dilaudid is an appropriate analgesic for this patient. Ibuprofen may not be an effective analgesic for a patient with a 6 on a 0 to 10 pain scale. Promethazine is an antiemetic, and although it may be ordered, it would not be for pain control. Morphine is not used for this type of pain, as it is believed to cause spasms in the bile duct that would increase the pain.

The nurse is caring for a patient in the icteric phase of hepatitis and knows that which symptoms will most likely be seen? 1. Anorexia, rash, arthralgia, and fever 2. Fatigue, malaise, and liver enlargement 3. Malaise, severe headache, and urticaria 4. Jaundice, light- or clay-colored stools, and dark urine

4. Jaundice, light- or clay-colored stools, and dark urine The icteric phase is characterized by jaundice, light- or clay-colored stools, and dark urine, typical of impaired bile production and secretion. Pruritus may be present and is caused by the accumulation of bile salts under the skin. Gastrointestinal symptoms from the preicteric phase often persist. Signs and symptoms of the preicteric phase include malaise, severe headache, right upper quadrant abdominal pain, anorexia, nausea, vomiting, fever, arthralgia, rash, enlarged lymph nodes, urticaria, and enlargement and tenderness of the liver. Signs and symptoms of the posticteric phase include fatigue, malaise, and liver enlargement.

The nurse is to administer lactulose to a patient in a hepatic coma to reduce the patient's blood ammonia level. Which outcome would the nurse anticipate if the medication is effective? 1. Urine output will increase 2. Loose stools will decrease 3. Abdominal girth will decrease 4. Level of consciousness will improve

4. Level of consciousness will improve Cephulac is a laxative used to eliminate excess ammonia from the gastrointestinal tract, which is the cause of hepatic encephalopathy. Excess ammonia causes confusion and a decreasing level of consciousness. Loose stools would increase as a result of the medication; Cephulac has no effect on the kidneys/urine output or on reducing girth from accumulation of ascetic fluid.

A patient returns to the nursing unit after a liver biopsy. The nurse should immediately place the patient in which position? 1. Prone 2. Supine 3. Semi-Fowler 4. Right side-lying

4. Right side-lying 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.