MEDSURG TEST #2: CH 43 - Liver Cancer/Transplant, Pancreas and Gallbladder Problems

A client is to be discharged after a laparoscopic cholecystectomy. What statement indicates to the nurse that the client understands the discharge instructions? 1 "The bandages must be changed every day." 2 "I may have mild shoulder pain for about a week." 3 "The surgical sites should not be bathed for a week." 4 "I will remain on a full liquid diet for two more days."

2 "I may have mild shoulder pain for about a week."

A client who had a laparoscopic cholecystectomy reports pain in the shoulder. In what position should the nurse place the client? 1 Prone 2 Supine 3 Left Sims 4 Right side-lying

3 Left Sims

A client was diagnosed with cancer of the head of the pancreas two months ago. The client is admitted to the hospital with weight loss, severe epigastric pain, and jaundice. When performing the client's assessment, the nurse expects the client's stool to be what color? 1 Green 2 Brown 3 Red-tinged 4 Clay-colored

4

Fulminant viral hepatitis as a complication of viral hepatitis is highest in those individuals with a. hepatitis A b. Hepatitis C c. hepatitis B accompanied with hepatitis C d. hepatitis B accompanied with hepatitis D

D- Although fulminant hepatitis can occur with hepatitis A and hepatitis C, it is more common in hepatitis B, especially in Hep B infection accompanied by infection with Hep D virus

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.

The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder disease. Which statement by the patient to the nurse indicates she understands the instructions? A. "This medication will help me digest fats and fat-soluble vitamins." B. "I will apply the medicated lotion sparingly to the areas where I itch." C. "The medication is a powder and needs to be mixed with milk or juice." D. "I should take this medication on an empty stomach at the same time each day."

C. "The medication is a powder and needs to be mixed with milk or juice." For treatment of pruritus, cholestyramine may provide relief. This is a resin that binds bile salts in the intestine, increasing their excretion in the feces. Cholestyramine is in powder form and should be mixed with milk or juice before oral administration.

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is most appropriate? A. "The hepatitis vaccine will provide immunity from this exposure and future exposures." B. "I am afraid there is nothing you can do since the patient was infectious before admission." C. "You will need to be tested first to make sure you don't have the virus before we can treat you." D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."

D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure." Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis.

The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (select all that apply) a. avoid nicotine b. eat bland foods c. observe stools for steatorrhea d. eat high fat, low protein, high carbohydrate meals e. take prescribed pancreatic enzymes immediately following meals

a. avoid nicotine b. eat bland foods c. observe stools for steatorrhea Measures to prevent attacks of pancreatitis are those that decrease stimulation of the pancreas. lower fat intake, and foods that are irritating (eat bland), higher carbs are less stimulating, avoid alcohol and nicotine, monitor for steatorrhea (fat in feces). Pancreatic enzymes should be taken with meals, not after.

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings?

alcohol abuse

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 OTC antiemetics is N/V 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

When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level in the chart. d. Notify the health care provider immediately.

c. Check the calcium level in the chart.

A client is diagnosed with cancer of the pancreas and is apprehensive and restless. Which nursing action should be included in the plan of care? 1 Encouraging expression of concerns 2 Administering antibiotics as prescribed 3 Teaching the importance of getting rest 4 Explaining that everything will be all right

1 Encouraging expression of concerns

A client is admitted with the diagnosis of acute pancreatitis. For which clinical manifestations should a nurse assess the client? (Select all that apply.) 1 Jaundice 2 Acute pain 3 Hypertension 4 Hypoglycemia 5 Increased amylase

1 Jaundice 2 Acute pain 5 Increased amylase

When teaching a client about pancreatic function, the nurse understands that pancreatic lipase performs which function? A. Transports fatty acids into the brush border B. Breaks down fat into fatty acids and glycerol C. Triggers cholecystokinin to contract the gallbladder D. Breaks down protein into dipeptides and amino acids

B. Breaks down fat into fatty acids and glycerol

A 54-yr-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. Which diagnosis does the nurse expect? a. Starvation b. Pancreatitis c. Systemic sepsis d. Diabetic ketoacidosis

b. Pancreatitis

A risk factor associated with cancer of the pancreas is a. alcohol intake b. cigarette smoking c. exposure to asbestos d. increased dietary intake of milk and milk products

b. cigarette smoking

The nurse is caring for a 36-year-old patient with pancreatic cancer. Which nursing action is the highest priority? a. Offer psychologic support for depression. b. Offer high-calorie, high-protein dietary choices. c. Administer prescribed opioids to relieve pain as needed. d. Teach about the need to avoid scratching any pruritic areas.

c. Administer prescribed opioids to relieve pain as needed.

Laboratory test results that the nurse would expect to find in a patient with cirrhosis include a. serum albumin 7.0 g/dL b. bilirubin total 3.2 mg/dL c. serum cholesterok 260 mg/dL d. aspartate aminotransferase (AST) 6.0 U/L

B- Serum bilirubin, both direct and indirect, would be expected to be increased in cirrhosis. Serum albumin and cholesterol are decreased, and liver enzymes, such as AST and ALT, are elevated

in planning care for a patient with metastatic liver cancer, the nurse should include interventions that a. focus primarily on symptomatic and comfort measures b. reassure the patient that chemo offers a good prognosis c. promote the patients confidence that surgical excision of the tumor will be successful d. provide information necessary for the patient to make decisions regarding liver transplants

a. focus primarily on symptomatic and comfort measures

Combined with clinical manifestations, the laboratory finding that is most commonly used to diagnose acute pancreatitis is a. increased serum calcium b. increased serum amylase c. increased urinary amylase d. decreased serum glucose

b. increased serum amylase

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient with acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Abdominal tenderness and guarding d. Muscle twitching and finger numbness

d. Muscle twitching and finger numbness

Which assessment finding is of most concern for a 46-year-old woman with acute pancreatitis? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass

d. Palpable abdominal mass

A nurse is caring for a client with cholelithiasis and obstructive jaundice. When assessing this client, the nurse should be alert for which common clinical indicators associated with these conditions? (Select all that apply.) 1 Ecchymosis 2 Yellow sclera 3 Dark brown stool 4 Straw-colored urine 5 Pain in right upper quadrant

1 Ecchymosis 2 Yellow sclera 5 Pain in right upper quadrant

A client reports experiencing nausea, dyspnea, and right upper quadrant pain unrelieved by antacids. The pain occurs most often after eating in fast-food restaurants. Which diet should the nurse instruct the client to follow? 1 Low fat 2 Low carbohydrate 3 Soft textured and bland 4 High protein and kilocalories

1 Low fat

A client who is obese and has a history of alcohol abuse is admitted to the hospital with the diagnosis of acute pancreatitis. What is the priority expected client outcome in response to therapy at this time? 1 Report decreased pain. 2 Remain in fluid balance. 3 Lose four pounds a week. 4 Join Alcoholics Anonymous

1 Report decreased pain.

A client is admitted with a tentative diagnosis of pancreatitis. The medical and nursing measures for this client are aimed toward maintaining nutrition, promoting rest, maintaining fluid and electrolyte balance, and decreasing anxiety. Which interventions should the nurse implement? (Select all that apply.) 1 Provide a low fat diet. 2 Administer analgesics. 3 Teach relaxation exercises. 4 Encourage walking in the hall. 5 Monitor cardiac rate and rhythm. 6 Observe for signs of hypercalcemia

2 Administer analgesics. 3 Teach relaxation exercises. 5 Monitor cardiac rate and rhythm.

A client is admitted to the hospital for a laparoscopic cholecystectomy. What should the nurse encourage the client to add to the diet to help normalize bowel function after surgery? 1 Vitamins 2 Whole bran 3 Cod liver oil 4 Amino acids

2 Whole bran

The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer? A. Serum α-fetoprotein level B. Ventilation/perfusion scan C. Hepatic structure ultrasound D. Abdominal girth measurement

C. Hepatic structure ultrasound Correct Hepatic structure ultrasound, CT, and MRI are used to screen and diagnose liver cancer. Serum α-fetoprotein level may be elevated with liver cancer or other liver problems. Ventilation/perfusion scans do not diagnose liver cancer. Abdominal girth measurement would not differentiate between cirrhosis and liver cancer.

Pierre who is diagnosed with acute pancreatitis is under the care of Nurse Bryan. Which intervention should the nurse include in the care plan for the client? A. Administration of vasopressin and insertion of a balloon tamponade B. Preparation for a paracentesis and administration of diuretics C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction D. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day

C. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction

One of the most challenging nursing interventions to promote healing in the patient with viral hepatitis is a. providing adequate nutritional intake b. promoting strict bed rest during the icteric phase c. providing pain relief without using liver metabolized drugs. d. providing quiet diversional activities during periods of fatigue

A- Adequate nutrition is especially important in promoting regeneration of liver cells, but the anorexia of viral hepatitis is often severe, requiring creative and innovative nursing interventions. Strict bed rest is not usually required, and the patient usually has only minor discomfort from with hepatitis. Diversional activities may be required to promote psychologic rest but not during periods of fatigue

A patient newly diagnosed with acute hep B asks about drug therapy to treat the disease. The most appropriate response by the nurse is informing the patient that a. there are no specific drugs that are effective for treating acute viral hepatitis b, only chronic hep C is treatable, primarily with antiviral agents and alpha interferon. c. no drugs can be used for treatment of viral hepatitis because of the risk of additional liver damage. d. alpha interferon combined with lamivudine (EPivir) will decrease viral load and liver damage if taken for 1 year

A- No specific drugs are effective in treating acute viral hepatitis, although supportive drugs, such as anti-emetics, sedative, or atipruritics, may be used for symptom control. Antiviral agents, such as lamivudine or ribavirin, and alpha interferon may be used for treating chronic hepatitis B or C.

The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment? A. Spiral CT scan B. A PET/CT scan C. Abdominal ultrasound D. Cancer-associated antigen 19-9

D. Cancer-associated antigen 19-9 The cancer-associated antigen 19-9 (CA 19-9) is the tumor marker used for the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment. Although a spiral CT scan may be the initial study done and provides information on metastasis and vascular involvement, this test and the PET/CT scan or abdominal ultrasound do not provide additional information.

A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of pancreas and peritoneal irritation. In addition to effective use of analgesics, the nurse should a. provider diversional activities to distract the patient from pain b. provide small frequent meals to increase the patient's tolerance of food c. position the patient on the side with the head of the bed elevated 45 degrees for pain relief d. ambulate the patient every 3 to 4 hours to increase circulation and decrease abdominal congestion

c. position the patient on the side with the head of the bed elevated 45 degrees for pain relief

A 67-year-old male patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.

d. Abdominal pain is decreased.

Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective? a. Increased serum albumin level b. Decreased indirect bilirubin level c. Improved alertness and orientation d. Fewer episodes of bleeding varices

d. Fewer episodes of bleeding varices

The nurse provides teaching to a client who has received a prescription for oral pancreatic enzymes, pancrelipase (Viokase). The nurse evaluates that teaching is understood when the client states, "I will take them: 1 At bedtime." 2 With meals." 3 One hour before meals." 4 On arising each morning."

2 With meals."

The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobin (IG) injection? A. A caregiver who lives in the same household with the patient B. A friend who delivers meals to the patient and family each week C. A relative with a history of hepatitis A who visits the patient daily D. A child living in the home who received the hepatitis A vaccine 3 months ago

A. A caregiver who lives in the same household with the patient IG is recommended for persons who do not have anti-HAV antibodies and are exposed as a result of close contact with persons who have HAV or foodborne exposure. Persons who have received a dose of HAV vaccine more than 1 month previously or who have a history of HAV infection do not require IG.

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching? A. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis." B. "I need to take good care of my belly and ankle skin where it is swollen." C. "A scrotal support may be more comfortable when I have scrotal edema." D. "I can use pillows to support my head to help me breathe when I am in bed."

A. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis." If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider, as this is not normal for cirrhosis. Edematous tissue is subject to breakdown and needs meticulous skin care. Pillows and a semi-Fowler's or Fowler's position will increase respiratory efficiency. A scrotal support may improve comfort if there is scrotal edema.

When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include? A. A lower-fat diet may be better tolerated for several weeks. B. Do not return to work or normal activities for 3 weeks. C. Bile-colored drainage will probably drain from the incision. D. Keep the bandages on and the puncture site dry until it heals.

A. A lower-fat diet may be better tolerated for several weeks. Although the usual diet can be resumed, a low-fat diet is usually better tolerated for several weeks following surgery. Normal activities can be gradually resumed as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery, and the patient can shower.

You are caring for a post-operative cholecystectomy client. What should be reported immediately to the physician? A. The client reports severe RUQ tenderness. B. The client cannot void 4 hours post-operatively. C. Output does not equal input for the first few hours. D. The client reports shoulder pain.

A. The client reports severe RUQ tenderness.

The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient? A. Prevent all oral intake. B. Control abdominal pain. C. Provide enteral feedings. D. Avoid dietary cholesterol.

B. Control abdominal pain. Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. NPO status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis. Enteral feedings should not be needed, and avoiding dietary cholesterol is not used to treat cholelithiasis

In discussing long term management with the patient with alcoholic cirrhosis, the nurse advises the patient that a. a daily exercise regimen is important to increase the blood flow through the liver b. cirrhosis can be reversed if the patient follows a regimen of proper rest and nutrition c. abstinence from alcohol is the most important factor in improvement of the patient's condition d. the only over the counter analgesic that should be used for minor aches and pains is acetaminophen

C- Abstinence from alcohol is very important in alcoholic cirrhosis and may result in improvement if started when liver damage is reduced by rest and nutrition, most changes in the liver cannot be reversed. Exercise does not promote portal circulation, and very moderate exercise is recommended. Acetaminophen should not be used by the patient with liver disease because it is potentially hepatotoxic.

A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy? A. Low-grade fever of 100° F and dehydration B. Abscess in the right upper quadrant of the abdomen C. Activated partial thromboplastin time (aPTT) of 54 seconds D. Multiple obstructions in the cystic and common bile duct

C. Activated partial thromboplastin time (aPTT) of 54 seconds An aPTT of 54 seconds is above normal and indicates insufficient clotting ability. If the patient had surgery, significant bleeding complications postoperatively are very likely. Fluids can be given to eliminate the dehydration; the abscess can be assessed, and the obstructions in the cystic and common bile duct would be relieved with the cholecystectomy.

The nurse recognizes early signs of hepatic encephalopathy in the patient who a. manifests asterixis b. becomes unconscious c. has increasing oliguria d. is irritable and lethargic

D- Early signs of this neurologic condition include euphoria, depression, apathy, irritability, confusion, agitation, drowsiness, and lethargy. Loss of consciousness is usually preceded by asterixis, disorientation, hyperventilation, hypothermia, and alterations in reflexes. Increasing oliguria is a sign of hepatorenal syndrome.

The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. The best response by the nurse is a. "no immunization is available for hepatitis A, nor are you likely to get the disease" b. "only individuals who have had sexual contact with the patient should receive immunization" c. "all family members should receive the hepatitis A vaccine to prevent or modify the infection" d. "those who have had household or close contact with the patient should receive immune globulin"

D- Individuals who have been exposed to hepatitis A through household contact or foodborne outbreaks should be given immune globulin within 1 to 2 weeks of exposure to prevent or modify the illness. Hep A vaccine is used to provide pre-exposure immunity to the virus and is indicated for individuals at high risk for hep A exposure. Although hep A can be spread by sexual contact, the risk is higher for transmission with the oral-fecal route.

When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement? A. "I will use care when kissing my wife to prevent giving it to her." B. "I will need to take adofevir (Hepsera) to prevent chronic HCV." C. "Now that I have had HCV, I will have immunity and not get it again." D. "I will need to be checked for chronic HCV and other liver problems."

D. "I will need to be checked for chronic HCV and other liver problems." The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver cancer. HCV is not transmitted via saliva, but percutaneously and via high-risk sexual activity exposure. The treatment for acute viral hepatitis focuses on resting the body and adequate nutrition for liver regeneration. Adofevir (Hepsera) is taken for severe hepatitis B (HBV) with liver failure. Chronic HCV is treated with pegylated interferon with ribavirin. Immunity with HCV does not occur as it does with HAV and HBV, so the patient may be reinfected with another type of HCV.

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

a. checking for signs of hypocalcemia e. monitoring for infection, particularly respiratory tract infections

A nurse is caring for a client with cholelithiasis. Which clinical manifestation does the nurse expect if the client develops obstructive jaundice? 1 Yellow sclera 2 Pain on urination 3 Dark brown stools 4 Coffee-ground emesis

1 Yellow sclera

A client with cholecystitis is placed on a low fat, high protein diet. What nutrient should the nurse teach the client is included with this diet? 1 Skim milk 2 Boiled beef 3 Poached eggs 4 Steamed broccoli

1 Skim milk

A client with cholelithiasis has a laser laparoscopic cholecystectomy. Postoperatively it is most appropriate for the nurse to: 1 Maintain the client'sNPO for the first 24 hours 2 Monitor the client's abdominal incision for bleeding 3 Offer clear carbonated beverages to the client 4 Ambulate the client when the client is alert and oriented

4 Ambulate the client when the client is alert and oriented

Which of the following laboratory tests indicates a diagnosis of pancreatitis? A. Lipase 230 IU/L B. Calcium 6.0 mEq/L C. Blood glucose 65 mg/dL D. WBC count 5,000/mm3

A. Lipase 230 IU/L

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply)? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K E. Vitamin B

A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat-soluble and thus would need to be supplemented in a patient with biliary obstruction.

A patient with advanced cirrhosis has a nursing diagnosis of imbalanced nutrition: less than body requirements r/t anorexia and inadequate food intake. An appropriate midday snack for the patient would be a. peanut butter and salt free crackers b. a fresh tomato sandwich with salt free butter c. popcorn with salt free butter and herbal seasoning d. canned chicken noodle soup with low protein bread

B- The patient with advanced, complicated cirrhosis requires a high calore, high carbohydrate diet with moderate to low fat. Patients with cirrhosis are at risk for edema and ascites and their sodium intake should be limited. The tomato sandwich with salt free butter best meets these requirements. Rough foods, such as popcorn, may irritate the esophagus and stomach and lead to bleeding. Peanut butter is high in sodium and fat, and canned chicken noodle soup is very high in sodium

The nurse identifies a need for further teaching when the patient with hepatitis B states, a. I should avoid alcohol completely for as long as a year b. I must avoid all physical contact with my family until the jaundice is gone c. I should use a condom to prevent spread of the disease to my sexual partners d. I will need to rest several times a day, gradually increasing my activity as I tolerate it.

B- The patient with hep B is infectious for 4 to 6 months, and precautions to prevent transmission through percutaneous and sexual contact should be maintained until tests for HBsAg are negative. Close contact does not have to be avoided, but close contacts of the patient should be vaccinated. Alcohol should not be used for at least a year, and rest with increasing activity during convalescence is recommended

For Rico who has chronic pancreatitis, which nursing intervention would be most helpful? A. Allowing liberalized fluid intake B. Counseling to stop alcohol consumption C. Encouraging daily exercise D. Modifying dietary protein

B. Counseling to stop alcohol consumption

The client with pancreatitis may exhibit Cullen's sign on physical examination. Which of the following data best describes Cullen's sign? A. Jaundiced sclera B. Pain that occurs with movement C. Bluish discoloration of the left flank area D. Bluish discoloration of the periumbilical area

D. Bluish discoloration of the periumbilical area

The nurse is planning care for a 48-year-old woman with acute severe pancreatitis. The highest priority patient outcome is a. maintaining normal respiratory function. b. expressing satisfaction with pain control. c. developing no ongoing pancreatic disease. d. having adequate fluid and electrolyte balance.

a. maintaining normal respiratory function.

The nurse recognizes that teaching a 44-year-old woman following a laparoscopic cholecystectomy has been effective when the patient states which of the following? a. "I can expect yellow-green drainage from the incision for a few days." b. "I can remove the bandages on my incisions tomorrow and take a shower." c. "I should plan to limit my activities and not return to work for 4 to 6 weeks." d. "I will always need to maintain a low-fat diet since I no longer have a gallbladder."

b. "I can remove the bandages on my incisions tomorrow and take a shower."

The nurse is caring for a group of patients. Which patient has the highest risk for developing pancreatic cancer? a. A 38-yr-old Hispanic woman who is obese and has hyperinsulinemia b. A 72-yr-old African American man who has smoked cigarettes for 50 years c. A 23-yr-old man who has cystic fibrosis-related pancreatic enzyme insufficiency d. A 19-yr-old patient who has a 5-year history of uncontrolled type 1 diabetes mellitus

b. A 72-yr-old African American man who has smoked cigarettes for 50 years

During discharge instructions for a patient following a laparoscopic cholecystectomy, the nurse advises the patient to a. keep the incision areas clean and dry for at least a week b. report the need to take pain medication for shoulder pain c. report any bile colored or purulent drainage from the incisions d. expect some postoperative nausea and vomiting for a few days

c. report any bile colored or purulent drainage from the incisions

A client with chronic pancreatitis is being discharged from the hospital. Which of the following statements by the client demonstrates that the client understands how to take prescribed pancreatic enzyme replacements? a.) "I must take capsules three times daily spaced about 8 hours apart." b.) "I must take the medication when I wake up and before bed." c.) "I must take the medication with meals and snacks." d.) "I must take the capsules every 4 hours while awake."

c.) "I must take the medication with meals and snacks."

A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "What does my drinking have to do with my diagnosis?" What effect of alcohol should the nurse include when responding? 1 Promotes the formation of calculi in the cystic duct 2 Stimulates the pancreas to secrete more insulin than it can immediately produce 3 Alters the composition of enzymes so they are capable of damaging the pancreas 4 Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

4 Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

The nurse is creating a dietary plan for a client with cholecystitis who has been placed on a modified diet. What would be appropriate to include in the dietary plan? 1 Soft-textured foods to reduce the digestive burden 2 Low-cholesterol foods to avoid further formation of gallstones 3 Increased protein intake to promote tissue healing and improve energy reserves 4 Decreased fat intake to avoid stimulation of the cholecystokinin mechanism for bile release

4 Decreased fat intake to avoid stimulation of the cholecystokinin mechanism for bile release

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

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome (select all that apply)? A. Use smallest gauge needle possible when giving injections or drawing blood. B. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. C. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. D. Apply gentle pressure for the shortest possible time period after performing venipuncture. E. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

A. Use smallest gauge needle possible when giving injections or drawing blood. B. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. C. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. E. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present. Using the smallest gauge needle for injections will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush and avoidance of irritating food will reduce injury to highly vascular mucous membranes. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. Aspirin and NSAIDs should not be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for bleeding

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care? A. Immediately start enteral feeding to prevent malnutrition. B. Insert an NG and maintain NPO status to allow pancreas to rest. C. Initiate early prophylactic antibiotic therapy to prevent infection. D. Administer acetaminophen (Tylenol) every 4 hours for pain relief.

B. Insert an NG and maintain NPO status to allow 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. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.

The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit? A. Hematochezia B. Left upper abdominal pain C. Ascites and peripheral edema D. Temperature over 102o F (38.9o C)

B. Left upper abdominal pain Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. Other manifestations of acute pancreatitis include nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with muscle guarding is common. Bowel sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall may occur. Other areas of ecchymoses are the flanks (Grey Turner's spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen's sign, a bluish periumbilical discoloration).

When caring for a patient with autoimmune hepatitis, the nurse recognizes that, unlike viral hepatitis, the patient a. does not manifest hepatomegaly or jaundice b. experiences less liver inflammation and damage c. is treated with corticosteroids or other immunosuppressant agents d. is usually an older adult who has used a wide variety of prescription and over the counter drugs

C- Immunosuppressive agents are indicated i hepatitis associated with immune disorders to decrease liver damage caused by autoantibodies. Autoimmune hepatitis is similar to viral hepatitis in presenting signs and symptoms and may become chronic and lead to cirrhosis.

During the incubation period of viral hepatitis, the nurse would expect the patient to report a. pruritus and malaise b. dark urine and easy fatigability c. anorexia and right upper quadrant discomfort d. constipation or diarrhea with light colored stools

C- Incubation symptoms occur before the onset of jaundice and include a variety of GI symptoms as well as discomfort and heaviness in the upper right quadrant of the abdomen. Pruritus, dark urine, and light colored stools occur with the onset of jaundice in the acute phase.

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings? A. Malnutrition B. Osteomyelitis C. Alcohol abuse D. Diabetes mellitus

C. Alcohol Use The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal 30-122 U/L) and serum lipase (normal 31-186 U/L) levels as shown.

The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation? A. Has completed a college education B. Has been able to stop smoking cigarettes C. Has well-controlled type 1 diabetes mellitus D. The chest x-ray showed another lung cancer lesion.

D. The chest x-ray showed another lung cancer lesion. Contraindications for liver transplant include severe extrahepatic disease, advanced hepatocellular carcinoma or other cancer, ongoing drug and/or alcohol abuse, and the inability to comprehend or comply with the rigorous post-transplant course.

A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a peritoneovenous shunt. As a result of this procedure, the nurse would expect the patient to experience a. an improved survival rate b. decreased serum ammonia levels c. improved metabolism of nutrients d. improved hemodynamic function and renal perfusion

D- By shunting fluid sequestered in the peritoneum into the venous system, pressur eon esophageal veins is decreased, and more volume is returned to the circulation, improving CO and renal perfusion. However, because ammonia is diverted past the liver, hepatic encephalopathy continues. These procedures do not prolong life or promote liver function.

The systemic effects of viral hepatitis are caused primarily by a. cholestasis b. impaired portal circulation c. toxins produced by the infected liver d. activation of the complement system by antigen-antibody complexes

D- The systemic manifestations of rash, angioedema, arthritis, fever, and malaise in viral hepatitis are caused by the activation o the complement system by circulating immune complexes. Liver manifestations include jaundice from hepatic cell damage and cholestasis as well as anorexia perhaps caused by toxins produced by the damaged liver. Impaired portal circulation usually does not occur in uncomplicated viral hepatitis but would be a liver manifestation

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what? A. Relief of constipation B. Relief of abdominal pain C. Decreased liver enzymes D. Decreased ammonia levels

D. Decreased ammonia levels. Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy

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 assessment information will be most important for the nurse to report to the health care provider about a patient with acute cholecystitis? a. The patient's urine is bright yellow. b. The patient's stools are tan colored. c. The patient has increased pain after eating. d. The patient complains of chronic heartburn.

b. The patient's stools are tan colored.

The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. The nurse explains to the patient that this test a. is noninvasive and is a very reliable method of detecting gallstones b. is used only when other tests cannot be used because of allergy to contrast media c. is an adjunct to liver function tests to determine whether the gallbladder is inflamed d. will outline the gallbladder and the ductal system to enable visualization of stones

a. is noninvasive and is a very reliable method of detecting gallstones Ultrasonography is 90-95% accurate in detecting gallstones, and is noninvasive. Liver function tests will be elevated if there is damage to the liver, not with gallbladder.

A patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. Which intervention should the nurse include in the patient's plan of care? a. Immediately start enteral feeding to prevent malnutrition. b. Insert an NG and maintain NPO status to allow pancreas to rest. c. Initiate early prophylactic antibiotic therapy to prevent infection. d. Administer acetaminophen (Tylenol) every 4 hours for pain relief.

b. Insert an NG and maintain NPO status to allow pancreas to rest.

The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain by suppressing pancreatic secretions is the use of a. antibiotics. b. NPO status. c. antispasmodics. d. proton pump inhibitors.

b. NPO status.

Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a 62-year-old female patient who has acute pancreatitis? a. Calcium b. Bilirubin c. Amylase d. Potassium

c. Amylase

Management of the patient with acute pancreatitis include a. surgery to remove the inflamed pancreas b. pancreatic enzymes administered with meals c. NG suction to prevent gastric contents from entering the duodenum d. endoscopic pancreatic sphncterectomy using ERCP

c. NG suction to prevent gastric contents from entering the duodenum

Following laparoscopic cholecystectomy, the nurse would expect the patient to a. return to work in 2 to 3 weeks b. be hospitalized for 3 to 5 days postoperatively c. have four small abdominal incisions covered with small dressings d. have a T tube placed in the common bile duct to provide bile drainage

c. have four small abdominal incisions covered with small dressings

The patient with chronic pancreatitis is more likely than the patient with acute pancreatitis to a. need to abstain from alcohol b. experience acute abdominal pain c. have malabsorption and diabetes mellitus d. require a high carbohydrate, high protein, low fat diet

c. have malabsorption and diabetes mellitus Chronic damage to the pancreas causes pancreatic exocrine and endocrine insufficiency, resulting in a deficiency of digestive enzymes and insulin. Malabsorption and diabetes often result.

The nurse determines that further discharge instruction is needed when the patient with acure pancreatitis states, a. i should observe for fat in my stools b. i must not use alcohol to prevent future attacks of pancreatitis c. i shouldn't eat salty foods or foods with high amounts of sodium d. i will need to continue to monitor my blood glucose levels until my pancreas is healed

c. i shouldn't eat salty foods or foods with high amounts of sodium Sodium restriction isn't indicated for pancreatit

A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. the explanation includes the information that a Whipple procedure involves a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum b. resection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common bile duct and the stomach into the duodenum c. removal of part of the pancreas, part of the stomach, and the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum.

c. removal of part of the pancreas, part of the stomach, and the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum.

A patient with cirrhosis asks the nurse about the possibility of a liver transplant. The best response by the nurse is a. Liver transplants are only indicated in children with irreversible liver disease b. if you are interested in a transplant, you really should talk to your doctor about it c. rejection is such a problem in liver transplants that is seldom attempted in patients with cirrhosis d. cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?

d. cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?

The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that a. shock-wave therapy should be tried initially b. once gallstones are removed, they tend not to recur c. the disorder can be successfully treated with oral bile salts that dissolve gallstones d. laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic

d. laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic

A 51-year-old woman had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to a. choose low-fat foods from the menu. b. perform leg exercises hourly while awake. c. ambulate the evening of the operative day. d. turn, cough, and deep breathe every 2 hours.

d. turn, cough, and deep breathe every 2 hours.