NCLEX Liver, Gallbladder, Pancreas

What is the recommended dietary treatment for a client with chronic cholecystitis? a. low-residue diet b. low-fat diet c. high-fiber diet d. low-protein diet

b. low-fat diet The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications.

A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function? a. 50 mg/dL b. 90 mg/dL c. 70 mg/dL d. 30 mg/dL

d. 30 mg/dL Hyperinsulinism is caused by overproduction of insulin by the pancreatic islets. Occasionally, tumors of nonpancreatic origin produce an insulinlike material that can cause severe hypoglycemia and may be responsible for seizures coinciding with blood glucose levels that are too low to sustain normal brain function (i.e., lower than 30 mg/dL [1.6 mmol/L])

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? a. Radioisotope liver scan b. Angiography c. Magnetic resonance imaging d. Electroencephalography

a. Radioisotope liver scan A radioisotope liver scan assesses liver size and hepatic blood flow and obstuction. Magnetic resonance imaging is used to identify normal structures and abnormalities of the liver and biliary tree. Angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. Electroencephalography is used to detect abnormalities that occur with hepatic coma.

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply. a. fluid output b. blood coagulation c. fluid accumulation d. venous pressure

c. fluid accumulation d. venous pressure Methods of treating portal hypertension aim to reduce venous pressure and fluid accumulation.

A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment? a. "The tube allows the gastrointestinal tract to rest." b. "The tube provides relief from nausea and vomiting." c. "The tube allows toxins to be removed." d. "The tube helps control fluid and electrolyte imbalance."

a. "The tube allows the gastrointestinal tract to rest." Postoperative management of clients who have undergone a pancreatectomy or a pancreaticoduodenectomy is similar to the management of clients after extensive gastrointestinal or biliary surgery. An NG tube with suction and parenteral nutrition allow the gastrointestinal tract to rest while promoting adequate nutrition.

The single modality of pharmacologic therapy for chronic type B viral hepatitis is: a. Alpha-interferon b. Hepsera c. Epivir d. Baraclude

a. Alpha-interferon Alpha-interferon is a biologic response modifier that is highly effective for treatment of hepatitis B. The other antiviral agents are effective but not the preferred single-agent therapy.

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? a. To decrease metabolism b. To depress the central nervous system and increase the pain threshold c. To reduce gastric and pancreatic secretions d. To relieve nausea and vomiting

c. To reduce gastric and pancreatic secretions Anticholinergic medications reduce gastric and pancreatic secretion.

Which position should be used for a client undergoing a paracentesis? a. Prone b. Supine c. Upright at the edge of the bed d. Trendelenburg

c. Upright at the edge of the bed The client should be placed in an upright position on the edge of the bed or in a chair with the feet supported on a stool. The Fowler position should be used for the client confined to bed.

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis? a. Diarrhea b. Fatigue c. Hypertension d. Weight loss

d. Weight loss Weight loss is most common in the client with chronic pancreatitis due to decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. The other answer choices are not the most common complications related to chronic pancreatitis.

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? a. Assisting the client to turn, cough, and deep breathe every 2 hours b. Assisting the client to ambulate the evening of the operative day c. Performing range-of-motion (ROM) leg exercises hourly while the client is awake d. Teaching the client to choose low-fat foods from the menu

a. Assisting the client to turn, cough, and deep breathe every 2 hours Assessment should focus on the client's respiratory status. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The other nursing actions are also important, but are not as high a priority as ensuring adequate ventilation.

A client is receiving vasopressin for the urgent management of active bleeding due to esophageal varices. What most serious complication should the nurse assess the client for after the administration? a. Liver enzyme changes b. Electrocardiogram changes c. Urinary output changes d. Electrolytes level changes

b. Electrocardiogram changes Vasopressin (Pitressin) is administered during the management of an urgent situation with an acute esophageal bleed because of its vasoconstrictive properties in the splanchnic, portal, and intrahepatic vessels. This medication also causes coronary artery constriction that may dispose clients with coronary artery disease to cardiac ischemia; therefore, the nurse observes the client for evidence of chest pain, ECG changes, and vital sign changes. Vasopressin will does not infer with urinary output, electrolytes, or liver enzymes.

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? a. Cholecystectomy b. Endoscopic retrograde cholangiopancreatography (ERCP) c. Colonoscopy d. Abdominal x-ray

b. Endoscopic retrograde cholangiopancreatography (ERCP) ERCP locates stones that have collected in the common bile duct. A colonoscopy will not locate gallstones but only allows visualization of the large intestine. Abdominal x-ray is not a reliable locator of gallstones. A cholecystectomy is the surgical removal of the gallbladder.

An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is: a. Dextromethorphan b. Ibuprofen c. Acetaminophen d. Benadryl

c. Acetaminophen Although any medication can affect liver function, use of acetaminophen (found in many over-the-counter medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Other medications commonly associated with liver injury include anesthetic agents, medications used to treat rheumatic and musculoskeletal disease, antidepressants, psychotropic medications, anticonvulsants, and antituberculosis agents.

The mode of transmission of hepatitis A virus (HAV) includes which of the following? a. Blood b. Saliva c. Fecal-oral d. Semen

c. Fecal-oral The mode of transmission of hepatitis A virus (HAV) occurs through fecal-oral route, primarily through person to person contact and/or ingestion of fecal contaminated food or water. Hepatitis B virus (HBV) is transmitted primarily through blood. HBV can be found in blood, saliva, semen, and can be transmitted through mucous membranes and breaks in the skin.

A client with suspected biliary obstruction due to gallstones reports changes to the color of his stools. Which stool color does the nurse recognize as common to biliary obstruction? a. Red b. Green c. Gray d. Black

c. Gray A gray-white stool color is common with a biliary obstruction because the stool is no longer colored with bile pigments.

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? a. Cure the cirrhosis b. Treat the esophageal varices c. Reduce fluid accumulation and venous pressure d. Promote optimal neurologic function

c. Reduce fluid accumulation and venous pressure Methods of treating portal hypertension aim to reduce fluid accumulation and venous pressure. There is no cure for cirrhosis; treating the esophageal varices is only a small portion of the overall objective. Promoting optimal neurologic function will not reduce portal hypertension.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? a. The client is relaxed and not in pain. b. The client didn't take his morning dose of lactulose (Cephulac). c. The client's hepatic function is decreasing. d. The client is avoiding the nurse.

c. The client's hepatic function is decreasing. The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN? a. Measure abdominal girth every shift b. Monitor for reports of nausea and vomiting c. Auscultate the abdomen for bowel sounds every 4 hours d. Measure blood glucose concentration every 4 to 6 hours

d. Measure blood glucose concentration every 4 to 6 hours Enteral or parenteral nutrition may be prescribed. In addition to administering enteral or parenteral nutrition, the nurse monitors the serum glucose concentration every 4 to 6 hours.

A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. What is an important education topic regarding ingestion of medications? a. Medications becoming ineffective in clients with liver disease b. Need for increased drug dosages c. Need for more frequently divided doses d. Metabolism of medications

d. Metabolism of medications Careful evaluation of the client's response to drug therapy is important because the malfunctioning liver cannot metabolize many substances.

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? a. Asterixis b. Cirrhosis c. Hepatic encephalopathy d. Portal hypertension

c. Hepatic encephalopathy Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with an elevated ammonia concentration that produces changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? a. Cirrhosis b. Asterixis c. Portal hypertension d. Hepatic encephalopathy

d. Hepatic encephalopathy Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with an elevated ammonia concentration that produces changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority? a. Imbalanced nutrition: Less than body requirements b. Fatigue c. Excess fluid volume d. Ineffective breathing pattern

d. Ineffective breathing pattern In ascites, accumulation of large amounts of fluid causes extreme abdominal distention, which may put pressure on the diaphragm and interfere with respiration. If uncorrected, this problem may lead to atelectasis or pneumonia. Although fluid volume excess is present, the diagnosis Ineffective breathing pattern takes precedence because it can lead more quickly to life-threatening consequences. The nurse can deal with fatigue and altered nutrition after the client establishes and maintains an effective breathing pattern.

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? a. Riboflavin b. Vitamin K c. Thiamine d. Vitamin A

d. Vitamin A Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a. black, tarry stools. b. yellow sclerae. c. light amber urine. d. circumoral pallor.

b. yellow sclerae. Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? a. The client is relaxed and not in pain. b. The client is avoiding the nurse. c. The client's hepatic function is decreasing. d. The client didn't take his morning dose of lactulose (Cephulac).

c. The client's hepatic function is decreasing. The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? a. "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." b. "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." c. "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated." d. "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use."

a. "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." If pain occurs in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure), the nurse may recommend using a heating pad for 15 to 20 minutes hourly, sitting up in a bed or chair, or walking.

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? a. "You must have the second one in 1 month and the third in 6 months." b. "You must have the second one in 1 year and the third the following year." c. "You must have the second one in 2 weeks and the third in 1 month." d. "You must have the second one in 6 months and the third in 1 year."

a. "You must have the second one in 1 month and the third in 6 months." Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis? a. Adventitious breath sounds and hypertension b. Pain with abdominal distention and hypotension c. Presence of blood in the client's stool and recent hypertension d. Presence of easy bruising and bradycardia

b. Pain with abdominal distention and hypotension Assessment findings associated with pancreatitis include pain with abdominal distention and hypotension. Blood in stools and recent hypertension aren't associated with pancreatitis; fatty diarrhea and hypotension are usually present. Presence of easy bruising and bradycardia aren't found with pancreatitis; the client typically experiences tachycardia, not bradycardia. Adventitious breath sounds and hypertension aren't associated with pancreatitis.

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: a. Excess potassium loss subsequent to prolonged use of diuretics. b. Excessive diuresis and dehydration. c. The digestion of dietary and blood proteins. d. Severe infections and high fevers.

c. The digestion of dietary and blood proteins. Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (ie, bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia.

The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu? a. Baked chicken with sweet potato french fries, cornbread, and tea b. Omelet with green peppers, onions, mushrooms, and cheese with milk c. Ham and cheese sandwich, baked beans, potatoes, and coffee d. Pancakes with butter and honey, and orange juice

d. Pancakes with butter and honey, and orange juice Teach clients to select a diet high in carbohydrates with protein intake consistent with liver function. The client should identify foods high in carbohydrates and within protein requirements (moderate to high protein in cirrhosis and hepatitis, low protein in hepatic failure). The client with acute hepatic encephalopathy is placed on a low-protein diet to decrease ammonia concentration. The other choices are all higher in protein. The client's ascites indicates that a low-sodium diet is needed, and the other choices are all high in sodium.

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a. Administering morphine I.V. as ordered b. Providing mouth care c. Maintaining nothing-by-mouth (NPO) status d. Placing the client in a semi-Fowler's position

a. Administering morphine I.V. as ordered The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position? a. On the left side b. Trendelenburg c. High Fowler d. On the right side

d. On the right side Immediately after the biopsy, assist the client to turn on to the right side; place a pillow under the costal margin, and caution the client to remain in this position. In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Positioning the client on the left side is not indicated. Positioning the client in the Trendelenburg position may be indicated if the client is in shock, but it is not the position designed for the client after liver biopsy. The high Fowler position is not indicated for the client after liver biopsy.

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. A healthcare provider orders a liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. What should the nurse suspect? a. Perforation of the colon caused by the liver biopsy b. Normal postprocedural pain, with a change in the level of consciousness resulting from the pre-existing fever c. An allergic reaction to the contrast media used during the liver biopsy d. Peritonitis from bleeding in the liver caused by the liver biopsy

d. Peritonitis from bleeding in the liver caused by the liver biopsy After any invasive procedure, the nurse must stay alert for complications in the affected region—in this case, the abdomen. This client exhibits classic signs and symptoms of peritonitis caused by blood or bile after the liver biopsy. There is a reason to suspect bleeding resulting from the liver biopsy. It is rare to have a perforation of the colon after a biopsy. Liver biopsy doesn't involve the use of contrast media. The client's symptoms are not normal for a liver biopsy.

T/F: Serum ALT is increased more markedly than AST in liver disease

True: Serum ALT is increased more markedly than AST in liver disease, whereas AST is more increased in myocardial necrosis. ALT levels are normal or slightly elevated in myocardial necrosis. ALT levels return more slowly to normal range than AST levels in liver conditions. Normal serum ALT is 10-35 units/L. Normal serum AST is 8-38 units/L

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? a. "How did this happen? I've been faithful my entire marriage." b. "I'll wash my hands often." c. "I'll be very careful when preparing food for my family." d. "I'll take all my medications as ordered."

a. "How did this happen? I've been faithful my entire marriage." The client requires further teaching if he suggests that he acquired the virus through sexual contact. Hepatitis A is transmitted by the oral-fecal route or through ingested food or liquid that's contaminated with the virus. Hepatitis A is rarely transmitted through sexual contact. Clients with hepatitis A need to take every effort to avoid spreading the virus to other members of their family with precautions such as preparing food carefully, washing hands often, and taking medications as ordered.

Alcohol, which is toxic to the liver, is a common cause of hepatic disorders. As part of health teaching, the nurse advises a group of women that the amount of daily alcohol use should generally be limited to the equivalent of: a. 1 drink b. 2 drinks c. 3 drinks d. 4 drinks

a. 1 drink Current guidelines from the CDC and the Dietary Guidelines for Americans define moderate alcohol consumption as up to one drink per day for women and up to two drinks per day for men. Current guidelines from the Canadian Centre on Substance Use and Addiction are up to 10 drinks per week with no more than 2 drinks per day for women and up to 15 drinks per week with no more than 3 drinks per day for men. A drink is commonly defined as 12 ounces of 5% alcohol content beer or cider, 5 ounces of wine, and 1.5 ounces of 80 proof distilled alcohol.

A client with calculi in the gallbladder is said to have: a. Cholelithiasis b. Cholecystitis c. Choledocholithiasis d. Choledochotomy

a. Cholelithiasis Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition. Cholecystitis is acute inflammation of the gallbladder. Choledocholithiasis is a gallstone in the common bile duct. Choledochotomy is an incision into the common bile duct.

Which type of deficiency results in macrocytic anemia? a. Folic acid b. Vitamin A c. Vitamin K d. Vitamin C

a. Folic acid Folic acid deficiency results in macrocytic anemia. Vitamin C deficiency results in hemorrhagic lesions of scurvy. Vitamin A deficiency results in night blindness and eye and skin changes. Vitamin K deficiency results in hypoprothrombinemia, which is characterized by spontaneous bleeding and ecchymosis.

A client with a lengthy history of alcohol addiction is being seen for jaundice. The appearance of jaundice would most likely indicate: a. Liver disorder b. Bile overproduction c. Gallbladder disease d. Glucose overproduction

a. Liver disorder Jaundice is a sign of disease, but it is not itself a unique disease. Jaundice accompanies many diseases that directly or indirectly affect the liver and is probably the most common sign of a liver disorder.

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? a. Pancreatitis b. Cholecystitis c. Appendicitis d. Peptic ulcer

a. Pancreatitis Hypotension is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. The other conditions are less likely to exhibit fluid volume deficit.

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? a. Serum amylase b. Serum bilirubin c. Serum calcium d. Serum potassium

a. Serum amylase Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. Serum amylase and lipase concentrations are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but the serum lipase concentration may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.

A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is boardlike and no bowel sounds are detected. What is the major concern for this patient? a. The patient has developed peritonitis. b. The patient has developed renal failure. c. The patient requires more pain medication. d. The patient is developing a paralytic ileus.

a. The patient has developed peritonitis. Abdominal guarding is present. A rigid or boardlike abdomen may develop and is generally an ominous sign, usually indicating peritonitis

A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider? a. tachycardia and tachypnea b. bradycardia and bradypnea c. bradycardia and tachypnea d. tachycardia and bradypnea

a. tachycardia and tachypnea With shock, the sympathetic nervous system "SNS" is activated due to changes in blood volume and blood pressure. The SNS stimulates the cardiovascular system, causing tachycardia; and the respiratory system, causing tachypnea. Tachycardia (not bradycardia) and tachypnea (not bradypnea) occur with the compensatory stage of shock.

Which of thee following statements made by the client will help the nurse know that education on serum prothrombin time has been effective? a. "Prothrombin time determines if I am anemic" b. "Prothrombin time evaluate clotting ability" c. "Prothrombin time indicates the pretense of an infection" d. "Prothrombin time evaluates liver function"

b. "Prothrombin time evaluate clotting ability" The client with hepatic cirrhosis has an increased risk of bleeding because of decreased production of prothrombin and decreased ability of the liver to synthesize the necessary substances for blood coagulation. b. Prothrombin is synthesized by the liver and is an inactive precursor in the clotting process. Prothrombin is converted to thrombin, which is needed to form a blood clot. Prothrombin time measures clotting ability. Normal prothrombin time is 10-13 seconds.

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy? a. Placing the client in the semi-Fowler position immediately after surgery b. Assessing the color of the sclera every shift c. Placing the client on NPO (nothing by mouth) status for 2 days after surgery d. Clamping the T-tube immediately after surgery

b. Assessing the color of the sclera every shift If bile is not draining properly, an obstruction is probably causing bile to be forced back into the liver and bloodstream. Because jaundice may result, the nurse should assess the color of the sclerae.

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a. Reduced hematocrit b. Clay-colored stools c. Elevated urobilinogen in the urine d. Straw-colored urine

b. Clay-colored stools Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam? a. It visualizes the liver and pancreas. b. It visualizes the gallbladder and bile duct. c. It visualizes the biliary structures and pancreas via endoscopy. d. It shows the sizes of the abdominal organs and detects any masses.

b. It visualizes the gallbladder and bile duct. The cholecystogram is a diagnostic imaging test used to visualize the gallbladder and bile duct. The celiac axis arteriography visualizes the liver and pancreas. Ultrasonography shows the sizes of the abdominal organs and detects any masses. The endoscopic retrograde cholangiopancreatography (ERCP) visualizes the biliary structures and pancreas via endoscopy.

Clinical manifestations of common bile duct obstruction include all of the following except: a. Jaundice b. Light-colored urine c. Clay-colored feces d. Pruritus

b. Light-colored urine The excretion of the bile pigments by the kidneys gives the urine a very dark color. The feces, no longer colored with bile pigments, are grayish, like putty, or clay-colored. The symptoms may be acute or chronic. Epigastric distress, such as fullness, abdominal distention, and vague pain in the right upper quadrant of the abdomen, may occur. If it goes untreated jaundice and pruritus can occur.

Which enzyme aids in the digestion of fats? a. Secretin b. Lipase c. Trypsin d. Amylase

b. Lipase Lipase is a pancreatic enzyme that aids in the digestion of fats. Amylase aids in the digestion of carbohydrates. Secretin is responsible for stimulating secretion of pancreatic juice. Trypsin aids in the digestion of protein.

A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal? a. Controlling bleeding b. Maintaining the airway c. Maintaining fluid volume d. Relieving the client's anxiety

b. Maintaining the airway Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway can be compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.

Which is the most common cause of esophageal varices? a. Ascites b. Portal hypertension c. Jaundice d. Asterixis

b. Portal hypertension Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? a. Furosemide (Lasix) b. Spironolactone (Aldactone) c. Acetazolamide (Diamox) d. Bumetanide (Bumex)

b. Spironolactone (Aldactone) Potassium-sparing diuretic agents such as spironolactone or triamterene (Dyrenium) may be indicated to decrease ascites, if present; these diuretics are preferred because they minimize the fluid and electrolyte changes commonly seen with other agents.

Alcohol, which is toxic to the liver, is a common cause of hepatic disorders. As part of health teaching, the nurse advises a group of women that the amount of daily alcohol use should be limited to the equivalent of: a. One 6 oz martini. b. Two 6 oz glasses of wine. c. One 2 oz glass of a mixed drink (gin and tonic). d. Two 12 oz bottles of beer.

b. Two 6 oz glasses of wine. Intake of 60 g/day for men and 30 g/d for women (10 g of alcohol is equivalent to 1 oz of bourbon, 12 ounces of beer, or 4 ounces of red wine) is sufficient to cause liver injury.

Which is a clinical manifestation of cholelithiasis? a. Abdominal pain in the upper left quadrant b. Nonpalpable abdominal mass c. Clay-colored stools d. Epigastric distress before a meal

c. Clay-colored stools The client with gallstones has clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored. The client develops a fever and may have a palpable abdominal mass.

A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client? a. Spironolactone b. Lactulose c. Octreotide d. Propranolol

c. Octreotide In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Octreotide (Sandostatin) causes selective splanchnic vasoconstriction by inhibiting glucagon release and is used mainly in the management of active hemorrhage. Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in clients with known varices and to prevent rebleeding. Beta-blockers should not be used in acute variceal hemorrhage, but they are effective prophylaxis against such an episode. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Lactulose (Cephulac) is administered to reduce serum ammonia levels in clients with hepatic encephalopathy.

The nurse is caring for a patient who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? (Select all that apply.) a. Assess and document vital signs every 4 hours. b. Measure urine output every 8 hours. c. Perform daily weights. d. Monitor number of bowel movements per day. e. Measure abdominal girth daily.

c. Perform daily weights. e. Measure abdominal girth daily. Increased abdominal girth and rapid weight gain are common presenting symptoms of ascites. If a patient with ascites from liver dysfunction is hospitalized, nursing measures include assessment and documentation of intake and output (I&O;), abdominal girth, and daily weight to assess fluid status. The nurse also closely monitors the respiratory status because large volumes of ascites can compress the thoracic cavity and inhibit adequate lung expansion. The nurse monitors serum ammonia, creatinine, and electrolyte levels to assess electrolyte balance, response to therapy, and indications of encephalopathy.

The nurse should teach the patient to assess for internal bleeding. What should the patient be monitoring? a. Bleeding gums b. Bruising c. Stools d. Scratches

c. Stools Blood in the stool is a sign of internal bleeding

The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include? a. "What type of over-the-counter pain reliever do you use?" b. "Have you had an infection recently?" c. "Does your work expose you to chemicals?" d. "How often do you drink alcohol?"

d. "How often do you drink alcohol?" The most common type of cirrhosis results from chronic alcohol intake and is frequently associated with poor nutrition. Although it can follow chronic poisoning with chemicals or ingestion of hepatotoxic drugs such as acetaminophen, asking about alcohol intake would be most important. Asking about an infection or exposure to hepatotoxins or industrial chemicals would be important if the client had postnecrotic cirrhosis.

Which term is used to describe a chronic liver disease in which scar tissue surrounds the portal areas? a. Biliary cirrhosis b. Compensated cirrhosis c. Postnecrotic cirrhosis d. Alcoholic cirrhosis

d. Alcoholic cirrhosis This type of cirrhosis is due to chronic alcoholism and is the most common type of cirrhosis. In postnecrotic cirrhosis, there are broad bands of scar tissue, which are a late result of a previous acute viral hepatitis. In biliary cirrhosis, scarring occurs in the liver around the bile ducts. Compensated cirrhosis is a general term given to the state of liver disease in which the liver continues to be able to function effectively.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: a. Severe abdominal pain radiating to the shoulder b. Eructation and constipation c. Abdominal ascites d. Anorexia, nausea, and vomiting

d. Anorexia, nausea, and vomiting Early hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.

Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels? a. Acetone in the urine b. High glucose concentration in the blood c. Dry mouth, which makes the client thirsty d. Frequent vomiting, leading to loss of fluid volume

d. Frequent vomiting, leading to loss of fluid volume Fluid and electrolyte disturbances are common complications because of nausea, vomiting, movement of fluid from the vascular compartment to the peritoneal cavity, diaphoresis, fever, and the use of gastric suction. The nurse assesses the client's fluid and electrolyte status by noting skin turgor and moistness of mucous membranes. The nurse weighs the client daily and carefully measures fluid intake and output, including urine output, nasogastric secretions, and diarrhea.

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease? a. Prevent visitors, so as not to agitate the client b. Raise all four side rails on the bed c. Apply soft wrist restraints d. Pad the side rails on the bed

d. Pad the side rails on the bed Padding the side rails can reduce injury if the client becomes agitated or restless. Restraints would not be an initial measure to implement. Four side rails are considered a restraint, and this would not be an initial measure to implement. Family and friends generally assist in calming a client.

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? a. Electroencephalography b. Magnetic resonance imaging c. Angiography d. Radioisotope liver scan

d. Radioisotope liver scan A radioisotope liver scan assesses liver size and hepatic blood flow and obstuction. Magnetic resonance imaging is used to identify normal structures and abnormalities of the liver and biliary tree. Angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. Electroencephalography is used to detect abnormalities that occur with hepatic coma.

A nurse is educating a client who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the dietary teaching? a. Decrease the amount of fats in the diet. b. Increase the amount of magnesium in the diet. c. Increase the amount of potassium in the diet. d. The amount of protein is not restricted in the diet.

d. The amount of protein is not restricted in the diet. Clients with hepatic encephalopathy and their families are advised that protein intake should not be restricted in hepatic encephalopathy, as was recommended in the past. Protein intake should be maintained at 1.2 to 1.5 g/kg per day. Electrolyte balance may need to be corrected with some clients, but there are no specific recommendations for potassium and magnesium. Fat intake is not limited in clients who have hepatic encephalopathy.

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? a. To relieve nausea and vomiting b. To decrease metabolism c. To depress the central nervous system and increase the pain threshold d. To reduce gastric and pancreatic secretions

d. To reduce gastric and pancreatic secretions Anticholinergic medications reduce gastric and pancreatic secretion.

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: a. wear a gown when providing personal care for the client. b. place the client in a private room. c. wear a mask when handling the client's bedpan. d. wash her hands after touching the client.

d. wash her hands after touching the client. To maintain enteric precautions, the nurse must wash her hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.

The digestion of carbohydrates is aided by: a. amylase. b. lipase. c. trypsin. d. secretin.

a. amylase. Amylase is secreted by the exocrine pancreas. Lipase aids in the digestion of fats. Trypsin aids in the digestion of proteins. Secretin is the major stimulus for increased bicarbonate secretion from the pancreas.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? a. Nitroglycerin b. Vasopressin c. Spironolactone d. Cimetidine

b. Vasopressin Vasopressin may be the initial therapy for esophageal varices because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.

The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose? a. Vomiting b. Watery diarrhea c. Asterixis d. Ringing in the ears

b. Watery diarrhea The patient receiving lactulose is monitored closely for the development of watery diarrhea stools, because they indicate a medication overdose. Serum ammonia levels are closely monitored as well.

When caring for a client with cirrhosis, which symptoms should a nurse report immediately? Select all that apply. a. anorexia and dyspepsia b. change in mental status c. diarrhea or constipation d. signs of GI bleeding

b. change in mental status d. signs of GI bleeding The nurse reports any change in mental status or signs of GI bleeding immediately because they indicate secondary complications.

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a. Anxiety related to unknown outcome of hospitalization b. Imbalanced nutrition: Less than body requirements related to biliary inflammation c. Deficient knowledge related to prevention of disease recurrence d. Acute pain related to biliary spasms

d. Acute pain related to biliary spasms The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

One difference between cholesterol stones (left) and the stones on the right are that the ones on the right account for only 10% to 25% of cases of stones in the United States. What is the name of the stones on the right? a. Patterned b. Pearl c. Pixelated d. Pigment

d. Pigment There are two major types of gallstones: those composed predominantly of pigment and those composed primarily of cholesterol. Pigment stones probably form when unconjugated pigments in the bile precipitate to form stones; these stones account for 10% to 25% of cases in the United States. There are no gallstones with the names of pearl, patterned, or pixelated.

After undergoing a liver biopsy, a client should be placed in which position? a. Prone position b. Supine position c. Semi-Fowler's position d. Right lateral decubitus position

d. Right lateral decubitus position After a liver biopsy, the client is placed on the right side (right lateral decubitus position) to exert pressure on the liver and prevent bleeding. Semi-Fowler's position and the supine and prone positions wouldn't achieve this goal.

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is: a. pancreatitis b. hepatitis B c. hepatitis A d. acute cholecystitis

d. acute cholecystitis Gallstones are more frequent in women, particularly women who are middle-aged and obese. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain that may radiate to the back and shoulders. The patient profile and symptoms are suggestive of acute cholecystitis.

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply. a. Petechiae b. Cyanosis of the lips c. Aphthous stomatitis d. Ecchymoses e. Jaundice

a. Petechiae d. Ecchymoses e. Jaundice The skin, mucosa, and sclerae are inspected for jaundice. The nurse observes the skin for petechiae or ecchymotic areas (bruises), spider angiomas, and palmar erythema. Cyanosis of the lips is indicative of a problem with respiratory or cardiovascular dysfunction. Aphthous stomatitis is a term for mouth ulcers and is a gastrointestinal abnormal finding.

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a. Urobilinogen b. Creatinine c. Albumin d. Chloride

c. Albumin Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? a. Hemoglobin b. Bilirubin c. Temperature d. Albumin

d. Albumin With the movement of albumin from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure, results in movement of fluid into the peritoneal cavity. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of ascites and edema.

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? a. Assisting the client to turn, cough, and deep breathe every 2 hours b. Performing range-of-motion (ROM) leg exercises hourly while the client is awake c. Assisting the client to ambulate the evening of the operative day d. Teaching the client to choose low-fat foods from the menu

a. Assisting the client to turn, cough, and deep breathe every 2 hours Assessment should focus on the client's respiratory status. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The other nursing actions are also important, but are not as high a priority as ensuring adequate ventilation.

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? a. Loss of 2.2 lb (1 kg) in 24 hours b. Serum potassium level of 3.5 mEq/L c. Blood pH of 7.25 d. Serum sodium level of 135 mEq/L

a. Loss of 2.2 lb (1 kg) in 24 hours Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. Which of the following clinical manifestations would indicate a common bile duct obstruction associated with a tumor in the head of the pancreas? Choose all that apply. a. Pruritis b. Jaundice c. Weight gain d. Clay-colored stools e. Dark urine

a. Pruritis, b. Jaundice, d. Clay-colored stools, e. Dark urine The obstructed flow of bile produces jaundice, clay-colored stools, and dark urine. Malabsorption of nutrients and fat-soluble vitamins may result if the tumor obstructs the entry of bile to the gastrointestinal tract. Abdominal discomfort or pain and pruritus may be noted, along with anorexia, weight loss, and malaise. If these signs and symptoms are present, cancer of the head of the pancreas is suspected.

A female client with chronic hepatitis B has been prescribed recombinant interferon alfa-2b in combination with ribavirin. Which of the following instructions should a nurse provide this client? a. Maintain an exercise regimen. b. Avoid hot water baths or soaks. c. Use strict birth control methods. d. Avoid calcium-rich foods.

c. Use strict birth control methods. A female client who has been prescribed recombinant interferon alpha-2b in combination with ribavirin should be instructed to use strict birth control methods. This is because ribavirin may cause birth defects. It is not essential for the client to avoid calcium-rich foods or hot baths or soaks. The client needs to maintain physical rest during therapy.

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a. Oral bile acids b. Potassium c. Vitamin K d. Vitamin B

c. Vitamin K Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a. Creatinine b. Chloride c. Urobilinogen d. Albumin

d. Albumin Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority? a. Nausea b. Disturbed body image c. Anxiety d. Impaired nutrition: less than body requirements

d. Impaired nutrition: less than body requirements While each diagnosis may be applicable to this client, the priority nursing diagnosis is impaired nutrition: less than body requirements. The physician, nurse, and dietitian emphasize to the client and family the importance of avoiding alcohol and foods that have produced abdominal pain and discomfort in the past. Oral food or fluid intake is not permitted during the acute phase.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: 1. Can digest high-fat foods 2. Are at risk for hepatic encephalopathy 3. Are at risk for gallbladder contraction 4. Cannot tolerate high-glucose concentration

4. Cannot tolerate high-glucose concentration Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

T/F: The patient with hepatic cirrhosis should NOT use an electric shaver

False With hepatic cirrhosis there is an increased risk for bleeding. Clients are educated to use an electric razor and soft bristled toothbrush to minimize risk for injury

A client has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has? a. Hemolytic jaundice b. Hepatocellular jaundice c. Cirrhosis of the liver d. Obstructive jaundice

d. Obstructive jaundice Obstructive jaundice is caused by a block in the passage of bile between the liver and intestinal tract. Hemolytic jaundice is caused by excess destruction of red blood cells. Hepatocellular jaundice is caused by liver disease. Cirrhosis of the liver would be an example of hepatocellular jaundice.

The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose? a. Vomiting b. Asterixis c. Ringing in the ears d. Watery diarrhea

d. Watery diarrhea The patient receiving lactulose is monitored closely for the development of watery diarrhea stools, because they indicate a medication overdose. Serum ammonia levels are closely monitored as well.

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: a. Cirrhosis b. Appendicitis c. Peptic ulcer disease d. Cholelithiasis

a. Cirrhosis Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

The nurse assesses a patient who is diagnosed with decompensated cirrhosis. Which of the following are clinical indicators consistent with that diagnosis? Select all that apply. a. Clubbing of the fingers b. Ascites c. Jaundice d. Vascular spiders e. A firm, enlarged liver f. Splenomegaly

a. Clubbing of the fingers, b. Ascites, c. Jaundice, d. Vascular spiders, e. A firm, enlarged liver Splenomegaly is categorized as a component of compensated cirrrhosis

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes melitus. Which of the following explains the cause of this secondary diabetes? a. Dysfunction of the pancreatic islet cells b. Ingestion of foods high in sugar c. Renal failure d. Inability for the liver to reabsorb serum glucose

a. Dysfunction of the pancreatic islet cells Diabetes mellitus resulting from dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents. The hazard of severe hypoglycemia with alcohol consumption is stressed to the client and family. When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. A standard treatment with pancreatitis is to make the client NPO. The dysfunction is related to the pancreas, not the liver.

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? a. Hypotension b. Polyuria c. Warm, moist skin d. Bradycardia

a. Hypotension Signs of potential hypovolemia include cool, clammy skin; tachycardia; decreased blood pressure; and decreased urine output.

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply. a. Petechiae b. Jaundice c. Ecchymoses d. Aphthous stomatitis e. Cyanosis of the lips

a. Petechiae, b. Jaundice, c. Ecchymoses The skin, mucosa, and sclerae are inspected for jaundice. The nurse observes the skin for petechiae or ecchymotic areas (bruises), spider angiomas, and palmar erythema. Cyanosis of the lips is indicative of a problem with respiratory or cardiovascular dysfunction. Aphthous stomatitis is a term for mouth ulcers and is a gastrointestinal abnormal finding.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a. Purpura and petechiae b. Ascites and orthopnea c. Dyspnea and fatigue d. Gynecomastia and testicular atrophy

a. Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a. Relieving abdominal pain b. Maintaining adequate nutritional status c. Teaching about the disease and its treatment d. Preventing fluid volume overload

a. Relieving abdominal pain The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after onset of the illness. Therefore, relieving abdominal pain is the nurse's primary goal. Because acute pancreatitis causes nausea and vomiting, the nurse should try to prevent fluid volume deficit, not overload. The nurse can't help the client achieve adequate nutrition or understand the disease and its treatment until the client is comfortable and no longer in pain.

Gynecomastia is a common side effect of which of the following diuretics? a. Spironolactone (Aldactone) b. Nitroglycerin (IV) c. Furosemide (Lasix) d. Vasopressin (Pitressin)

a. Spironolactone (Aldactone) Gynecomastia is a common side effect caused by spironolactone. Pitressin is used for bleeding esophageal varices and is not a diuretic. Nitroglycerin (IV) may be used with vasopressin to counteract the effects of vasoconstriction from the vasopressin.

Which of the following diagnostic studies definitely confirms the presence of ascites? a. Ultrasound of liver and abdomen b. Colonoscopy c. Abdominal x-ray d. Computed tomography of abdomen

a. Ultrasound of liver and abdomen Ultrasonography of the liver and abdomen will definitively confirm the presence of ascites. An abdominal x-ray, colonoscopy, and computed tomography of the abdomen would not confirm the presence of ascites.

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a. Vitamin K b. Oral bile acids c. Vitamin B d. Potassium

a. Vitamin K Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

AST is an enzyme that is mainly found in what organs in the body? Choose all that apply: a. heart b. gallbladder c. liver d. lungs

a. heart, c. liver AST is mainly found in the heart and liver. Moderate amounts may also be found in the pancreas, skeletal muscle, and kidneys

Which of the following is a primary classification of colchicine? a. Analgesic b. Antigout c. Antibiotic d. Anti-platelet

b. Antigout Colchicine is primarily used prophylactically for gout and to treat acute attacks. It has an unlabeled use for hepatic cirrhosis. Preliminary studies show increased survival rates for cirrhosis clients

When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions? a. Placing the patient in the prone position b. Frequent changes of positions c. Perform chest physiotherapy d. Suction the patient every 4 hours

b. Frequent changes of positions Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.

Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? a. Mashed potatoes b. Hot roast beef sandwich with gravy c. Vanilla pudding d. White rice

b. Hot roast beef sandwich with gravy The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated. The client should avoid fried foods such as fried chicken, because fatty foods may bring on an episode of cholecystitis.

A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system? a. Withhold oral feedings. b. Maintain the client in a semi-Fowler's position. c. Carry out wound care as prescribed. d. Administer enteral or parenteral nutrition.

b. Maintain the client in a semi-Fowler's position. The nurse maintains the client in the semi-Fowler's position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. Respiratory distress and hypoxia are common, and the client may develop diffuse pulmonary infiltrates, dyspnea, tachypnea, and abnormal blood gas values. The client who has undergone surgery may have multiple drains or an open surgical incision and is at risk for skin breakdown and infection. Oral food or fluid intake is not permitted; therefore, enteral or parenteral feedings may be prescribed.

When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? a. Report the condition to the physician immediately. b. Measure abdominal girth according to a set routine. c. Provide the client with nonprescription laxatives. d. Ask the client about food intake.

b. Measure abdominal girth according to a set routine. If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? a. Withhold oral feedings for the client. b. Reposition the client every 2 hours. c. Instruct the client to avoid coughing. d. Monitor pulse oximetry every hour.

b. Reposition the client every 2 hours. Repositioning the client every 2 hours minimizes the risk of atelectasis in a client who is being treated for pancreatitis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring the pulse oximetry helps show changes in respiratory status and promote early intervention, but it would do little to minimize the risk of atelectasis. Withholding oral feedings limits the reflux of bile and duodenal contents into the pancreatic duct.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? a. Cimetidine b. Vasopressin c. Spironolactone d. Nitroglycerin

b. Vasopressin Vasopressin may be the initial therapy for esophageal varices because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because they a. can digest high-fat foods. b. cannot tolerate a high glucose concentration. c. are at risk for hepatic encephalopathy. d. are at risk for gallbladder contraction.

b. cannot tolerate a high glucose concentration. Total parenteral nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high glucose concentration, even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas high protein intake increases risk for hepatic encephalopathy in clients with cirrhosis. Clients with pancreatitis should not be given high-fat foods because they are difficult to digest.

A client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which is the most appropriate response by the nurse? a. "You can use milk thistle instead of the medications you have been prescribed." b. "You should not use herbal supplements in conjunction with medical treatment." c. "Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated." d. "Herbal supplements are approved by the FDA, so there should be no problem with their usage if you check with your primary care provider."

c. "Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated." Many clients who have end-stage liver disease (ESLD) with cirrhosis use the herb milk thistle (Silybum marianum) to treat jaundice and other symptoms. This herb has been used for centuries because of its healing and regenerative properties in liver disease. Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. The natural compound SAM-e (s-adenosylmethionine) may improve outcomes of liver disease by improving liver function, possibly by enhancing antioxidant function. Herbal supplements are used in conjunction with medical treatment and medications. Herbal supplements are not approved by the FDA. Their usage should be discussed with the primary care provider to evaluate their effectiveness and interactions with other treatment regimens.

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a. Maintaining nothing-by-mouth (NPO) status b. Placing the client in a semi-Fowler's position c. Administering morphine I.V. as ordered d. Providing mouth care

c. Administering morphine I.V. as ordered The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? a. Constructional apraxia b. Ataxia c. Asterixis d. Fetor hepaticus

c. Asterixis Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy

When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? a. Blood tinged b. Yellow-green c. Clay-colored or whitish d. Black and tarry

c. Clay-colored or whitish Many clients report passing clay-colored or whitish stools as a result of no bile in the gastrointestinal tract. The other stool colors would not be absolute indicators of cirrhosis of the liver but may indicate other GI tract disorders.

The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition? a. Ultrasound b. MRI c. ERCP d. CT

c. ERCP The ERCP is the most useful study in the diagnosis of chronic pancreatitis. The other answer choices may be used; however, these are not the most useful in the diagnosis of chronic pancreatitis.

Which dietary modification is used for a client diagnosed with acute pancreatitis? a. High-fat diet b. Low-carbohydrate diet c. Elimination of coffee d. High-protein diet

c. Elimination of coffee A high-carbohydrate, low-fat, and low-protein diet should be implemented. Alcohol, caffeine, and spicy foods should be avoided.

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: a. Duodenum b. Common bile duct c. Gallbladder d. Cystic duct

c. Gallbladder The gallbladder functions as a storage depot for bile.

A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction? a. Paracentesis b. Azathioprine c. High-dose corticosteroids d. Liver transplantation

c. High-dose corticosteroids Drug-induced hepatitis occurs when a drug reaction damages the liver. This form of hepatitis can be severe and fatal. High-dose corticosteroids usually administered first to treat the reaction. Liver transplantation may be necessary. Paracentesis would be used to withdrawal fluid for the treatment of ascites. Azathioprine (Imuran) may be used for autoimmune hepatitis.

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? a. Serum potassium b. Serum bilirubin c. Serum amylase d. Serum calcium

c. Serum amylase Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. Serum amylase and lipase concentrations are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but the serum lipase concentration may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: a. elevated liver enzymes and low serum protein level. b. subnormal clotting factors and platelet count. c. subnormal serum glucose and elevated serum ammonia levels. d. elevated blood urea nitrogen and creatinine levels and hyperglycemia.

c. subnormal serum glucose and elevated serum ammonia levels. In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy? a. Negative Babinski reflex b. Irritability c. Increased motor activity d. Asterixis

d. Asterixis Hepatic encephalopathy is manifested by numerous central nervous system effects including: disorientation, confusion, personality changes, memory loss, a flapping tremor called asterixis, a positive Babinski reflex, sulfurous breath odor (referred to as fetor hepaticus), and lethargy to deep coma.

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? a. Lavage b. Gavage c. Instillation d. Decompression

d. Decompression Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting. Instillations in a nasogastric tube after surgery are done when necessary to promote patency; this is not the most common purpose of a nasogastric tube after surgery. Gavage is contraindicated after abdominal surgery until peristalsis returns. Lavage after surgery may be done to promote hemostasis in the presence of gastric bleeding, but this is not the most common purpose of a nasogastric tube after surgery.

A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas? a. Increases in the rate of pancreatic secretion b. Increases in the bicarbonate output by the kidneys c. Development of local complications d. Decreases in the physiologic function of major organs

d. Decreases in the physiologic function of major organs Acute pancreatitis affects people of all ages, but the mortality rate associated with acute pancreatitis increases with advancing age. The pattern of complications changes with age. Younger clients tend to develop local complications; the incidence of multiple organ failure increases with age, possibly as a result of progressive decreases in physiologic function of major organs with increasing age.

Which type of deficiency results in macrocytic anemia? a. Vitamin K b. Vitamin C c. Vitamin A d. Folic acid

d. Folic acid Folic acid deficiency results in macrocytic anemia. Vitamin C deficiency results in hemorrhagic lesions of scurvy. Vitamin A deficiency results in night blindness and eye and skin changes. Vitamin K deficiency results in hypoprothrombinemia, which is characterized by spontaneous bleeding and ecchymosis.

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? a. Fatigue durring ambulation b. Jaundice c. Pruritus of the arms and legs d. Irritability and drowsiness

d. Irritability and drowsiness Although all the options are associated with hepatitis B, the onset of irritability and drowsiness suggests a decrease in hepatic function. To detect signs and symptoms of disease progression, the nurse should observe for disorientation, behavioral changes, and a decreasing level of consciousness and should monitor the results of liver function tests, including the blood ammonia level. If hepatic function is decreased, the nurse should take safety precautions.