Module 4 exam

Alcoholism

Which condition is the primary risk factor for chronic calcifying pancreatitis?

Lipase

Which enzyme is involved in enzymatic fat necrosis of the endocrine and exocrine cells of the pancreas?

Kallikrein

Which enzyme is responsible for the release of vasoactive peptides, bradykinin, and a plasma kinin?

Constipation Decreased blood volume GI bleeding

Which factor may lead to hepatic encephalopathy for a patient with cirrhosis?

Hypokalemia High protein diet GI bleeding

Which factor may lead to the development of hepatic encephalopathy in a patient with cirrhosis?

Increase in serum levels of alkaline phosphatase

Which finding is expected in a patient who has a liver function abnormality?

Icterus, swollen abdomen, prolonged PTT

Which finding would the nurse expect for a patient with late-stage cirrhosis?

Lean meats

Which foods should be consumed in moderation for a patient with hepatic encephalopathy while the patient's serum ammonia level is elevated?

Do not stop taking abruptly

Which instruction would the nurse include when teaching a patient who has been prescribed lamivudine for treatment of chronic hepatitis B?

Elevated serum globulin

Which laboratory finding signifies an immune response to liver disease?

Liver function, WBC, Alkaline phosphate

Which laboratory result would the nurse review for a patient suspected of having cholecystitis?

Lactulose

Which medication may cause intestinal bloating and cramping for a patient who is being treated for hepatic encephalopathy?

Bile salts accumulate in the skin and cause the itching.

A nurse cares for a client who has obstructive jaundice. The client asks, "why is my skin so itchy?" How should the nurse respond?

Do you have a 1 or 2 story home?

A nurse prepares to discharge a client with chronic pancreatitis. Which question should the nurse ask to ensure safety upon discharge?

"Use a pill organizer to ensure you take this medication as prescribed."

A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this clients discharge education?

serum alanine aminotransferase (ALT)

A patient is diagnosed with acute pancreatitis. Which test is a sensitive indicator of biliary obstruction in this disorder?

chronic cholecystitis

A patient reports fever, yellowing of the skin and eyes, clay-colored stools, and dark urine. The nurse suspects further testing will reveal which condition?

Pancreatitis

A patient reports severe mid-epigastric pain radiating to the left flank and back. The nurse notes generalized jaundice and a gray-blue discoloration of the patient's abdomen and periumbilical area. The nurse suspects which cause of acute pain in this patient?

Biliary colic

A patient suspected of having cholecystitis presents with severe upper epigastric pain radiating to the right shoulder. The patient is vomiting and has abdominal distention. Which finding do these symptoms indicate?

Normal weight

A patient who has cholesterol-based gallstones and good gallbladder function is interested in nonsurgical management options for this condition. Which other factor must be present for this patient to be a candidate for a nonsurgical approach?

Vagina

A female patient is scheduled for a cholecystectomy by natural orifice transluminal endoscopic surgery. Which area is most commonly used for inserting the endoscope during this procedure?

Light colored stools

A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute?

Mid sterna chest pain

A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin) for bleeding esophageal varices. Which clinical manifestation should alert the nurse to a serious adverse effect?

Drainage from a fistula

A nurse assesses a client who is recovering from a Whipple procedure. Which assessment finding alerts the nurse to urgently contact the health care provider?

Urine output via indwelling urinary catheter is 20 mL/hr

A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse?

A 20-year-old college student who has had several sexual partners

A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B?

66 yo with a history of cirrhosis

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver?

Provide a low sodium diet

A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites?

Place the client in a semi fowlers position

A nurse cares for a client who is recovering from an open Whipple procedure. Which action should the nurse take

"Ambulating in the hallway twice a day will help."

A nurse cares for a client who is recovering from laparoscopic cholecystectomy surgery. The client reports pain in the shoulder blades. How should the nurse respond?

Less protein in the diet will help prevent confusion associated with liver failure.

A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond?

Creatinine 2.9

A nurse caring for a client with sickle cell disease (SCD) reviews the clients laboratory work. Which finding should the nurse report to the provider?

Bleeding esophageal varicies

A transjugular intrahepatic portal- systemic shunt (TIPS) may be placed to prevent which complication for a patient with ascites?

non-Hodgkin lymphoma (NHL)

All lymphoid cancers that do not have Reed-Sternberg cell. More than 60 sub types. Spreads in less orderly fashion and staging is more difficult Painless swollen lymph node Prognosis worse

"I need to avoid protein in my diet."

After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?

I may have been exposed when we ate shrimp last week

After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching?

I should eat plenty of fruits and vegetables

After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the clients understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching?

I will decrease the amount of fatty foods in my diet

After teaching a client who is recovering from laparoscopic cholecystectomy surgery, the nurse assesses the clients understanding. Which statement made by the client indicates a correct understanding of the teaching?

Assess the client by gently palpating the abdomen

An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel mark across the clients chest. Which action should the nurse take?

Stage 1

Characterized by slurred/slowed speech

CT with contrast

Provides more reliable image and diagnosis of acute pancreatitis

Intrahepatic obstruction

Clay-colored stools and dark urine are typically characteristic of which complication of viral hepatitis?

Chronic

Decreased serum total protein indicates which classification of liver disease?

Bilirubin

Elevation of which laboratory value is associated with jaundice for a patient with hepatitis?

Gadolinium

The oral or IV contrast material ________ is given before an MRCP scan. does not contain iodine; therefore it does not carry the risk for an allergic reaction.

Pancreatic cell injury

Which condition is indicated by an elevated serum lipase level?

late chronic cholecystitis

Icterus and steatorrhea are common findings in ___________

Smoking

In the health record of a patient newly diagnosed with pancreatic cancer, which clue would the nurse consider a risk factor?

Kallidin

Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known as ______. These substances cause vasodilation and increased vascular permeability, compounding the hemorrhagic process.

Asterixis

Liver flap; is related to increased serum ammonia levels--the dorsiflexed hands begin to flap upward and downward when outstretched for a few moments.

Bile

Liver produces a fluid called ____________.

With

Pancreatic enzymes should be taken ____ meals.

ERCP

Pancreatic stones are best diagnosed by:

Abdominal ultrasound

Most sensitive test to diagnose causes of pancreatitis, such as gallstones

HIDA scan

Nuclear med test; radioactive dye injected IV And scans trace flow of bile

chronic cholecystitis

Repeated episodes of cystic duct obstruction resulting in chronic inflammation; usually due to stones.

Acute pancreatitis

Serum alanine aminotransferase is a sensitive indicator of biliary obstruction in ____________. A threefold or greater rise in concentration indicates that the diagnosis is valid.

Biliary colic

Severe pain produced by obstruction of the cystic duct of the gallbladder or movement of one or more stones.

Pleural effusion

The nurse is caring tor a patient with acute pancreatitis. The patient is reporting shortness of breath and orthopnea. The patient's vital signs are blood pressure 140/80 mm Hg, pulse 110 beats/min, oxygen saturation 90% on room air, and temperature 99.8°F (37.6°C). Which complication does the nurse suspect?

Gadolinium

The nurse is preparing a patient for a magnetic resonance cholangiopancreatography(MRCP) scan. Which contrast medium does the nurse tell the patient will be administered before the procedure?

"These decreases may indicate further deterioration"

The nurse will respond in which way to a patient with long-standing alcoholic liver disease who has a decrease in serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) from previously assessed levels?

Alkaline phosphatase

an enzyme found in the liver, kidneys, and bones. An increase in serum levels indicates a liver function abnormality.

Proteolysis

occurs when pancreatic enzymes are released during pancreatitis, causes thrombosis and gangrene of the pancreas.

ERCP

performed to see if blockage is present and if stone can be removed

acute cholecystitis

inflammation of the gallbladder; usually caused by blockage from gallstones. Gallbladder can become necrotic

Stage 3

is characterized by hyperreflexia and muscle twitching.

Propanolol

is used to prevent Gl hemorrhage secondary to portal hypertension and gastroesophageal varices, which is an expected treatment for portal HTN

Hodgkin lymphoma

malignant disease originating in the lymphocytes (part of the body's immune system) that occurs most often in young adults and older men and characterized by the presence of unique Reed-Sternberg cells (malignant cells) in the lymph nodes; also called Hodgkin disease

Kehr sign

reflected by increased abdominal pain and exaggerated by deep breathing, and it is referred to the right shoulder.

Ascities Hemorrhoids Esophageal varicies

Portal hypertension related to cirrhosis can result in which complication?

Immunity to HAV after previous HAV infection

The presence of immunoglobulin G (lgG) hepatitis A virus (HAV) antibodies would indicate which condition?

Spironolactone

__________ is a potassium-sparing diuretic; additional potassium may result in potassium intoxication.

increased serum amylase, decreased serum calcium, and increased alanine aminotransferase.

A patient with acute pancreatitis will have an:

Chronic

A patient with cholecystitis has jaundice and icterus. These signs are typical of which type of cholecystitis?

Infectious status of the pt

A positive result from a hepatitis B surface antigen (HBsAg) test would indicate which condition for a patient who was previously treated for the hepatitis B virus (HBV)?

Postnecrotic

Which type of cirrhosis is caused by hepatitis C?

Maintain NPO and administer IV fluids

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this clients plan of care to reduce discomfort?

Pancreatic cancer

The patient with __________ is at a higher risk for developing venous emboli. This occurs because necrotic products of the pancreatic tumor have thromboplastic properties which, in turn, cause a hypercoagulable state.

Men who prefer sex with men

When providing community education, the nurse would emphasize that which group should receive immunization for hepatitis B?

Icterus

Which assessment finding is consistent with a diagnosis of viral hepatitis?

Itching Tea colored urine RUQ tenderness

Which assessment finding would the nurse expect for a patient with hepatitis B?

Consistency and number of stools

Which assessment finding would the nurse monitor to evaluate the effectiveness of pancreatic enzyme therapy?

Venous emboli

Which complication is common for a patient with pancreatic cancer to develop?

Hypovlemia

Which condition is the nurse concerned about for a patient with cirrhosis who has a weight gain of 2 kg, distention of the abdomen, a heart rate of 92 beats/min, and a blood pressure of 88/58 mm Hg?

Eat small meals at frequent intervals

Which diet instruction would the nurse give to a patient with active hepatitis?

pregnancy

Which factor is considered a risk factor in the development of cholelithiasis?

Ursodeoxycholic acid (UDCA)

Which medication would be administered after extracorporeal shock wave lithotripsy (ESWL) for treatment of cholelithiasis to dissolve remaining stone fragments?

Maintaining T tube in dependent position

Which nursing intervention would help prevent bile leakage and abscess formation after liver transplantation?

Kidney failure

Which patient condition would cause the nurse to question the use of neomycin for a patient with hepatic encephalopathy?

55-year-old American Indian woman with Crohn disease

Which patient has the highest risk for development of cholecystitis?

Pt with severe ascities and 101.4 temp

Which patient would the nurse attend to first?

Increased creatinine levels, increased osmolarity of urine, increased BUN

Which physiologic change would the nurse expect for a patient with severe liver disease who has developed hepatorenal syndrome?

Contrast enhanced CT

Which scan will provide the most reliable diagnosis of acute pancreatitis?

Abdominal pain

Which symptom of chronic pancreatitis also occurs with acute pancreatitis?

Icterus

Yellowing of sclera

Elevated INR and PT

_____ are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage

Hepatitis B

______ can be spread through sexual contact, needle sharing, needle sticks, blood transfusions, hemodialysis, acupuncture, and the maternal-fetal route.

Stage 2

______ of portal systemic encephalopathy is characterized by mental changes, mental confusion, and asterixis.

Stage 4

_______ is the stage in which patients experience seizures.