Hepatobiliary

A nurse is caring for a client with chronic hepatitis B and cirrhosis. Which of the following findings would indicate deficient vitamin K absorption as a result of the client's disease? A. Petechiae and purpura B. Asterixis C. Gynecomastia D. Ascites

A. Petechiae and purpura

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? Anxiety related to unknown outcome of hospitalization Imbalanced nutrition: Less than body requirements related to biliary inflammation Deficient knowledge related to prevention of disease recurrence Acute pain related to biliary spasms

Acute pain related to biliary spasms

A nurse is preparing to insert a nasogastric tube for a client with pancreatitis. In which of the following positions should the nurse place this client? A. Low Fowler's B. High Fowler's C. Left lateral D. Supine with the head flat

B. High Fowler's

A nurse is providing a teaching session to newly licensed nurses about the dietary needs of a client who is recovering from pancreatitis. Which of the following foods should the nurse include in the teaching as being low in fat? (Select all that apply.) A. Ribeye steak B. Oatmeal C. Ice cream D. Fresh peaches E. Pretzels

B. Oatmeal D. Fresh peaches E. Pretzels

A nurse is caring for a client diagnosed with a flare of chronic pancreatitis. Which of the following prescriptions does the nurse anticipate for this client? A. A diet that is high in potassium B. Enzymatic therapy C. A diet that is low in complex proteins D. Corticosteroid therapy

B. Enzymatic therapy Pancreatic enzyme replacement therapy is prescribed for clients with chronic pancreatitis to facilitate digestion, maintain nutritional status, and to relieve pain. The client should be advised to eat a diet that is high in protein and carbohydrates and low in fats. Corticosteroid therapy is not indicated. Pancreatitis does not lead to alterations of potassium levels, however, vitamins C and B can become depleted so these vitamins are often supplemented.

A nurse is caring for an adult client admitted for evaluation of pain in the epigastrium that is suspected to be pancreatitis. Which of the following tests does the nurse expect the healthcare provider to order to support this diagnosis? A. Vitamin B12 B. Serum amylase C. Serum lactate D. Hemoglobin and hematocrit E. Serum gastrin

B. Serum amylase

A nurse is caring for a client who was admitted early in the shift with pancreatitis. When evaluating the client's laboratory results, what is the immediate priority for intervention? A. White blood cell count 11,000 cells/mm^3 B. Sodium 118 mEq/L C. Potassium 3.5 mEq/L D. Serum amylase 120 units/dL

B. Sodium 118 mEq/L

A nurse is assigned to a client admitted to the emergency department with a suspected diagnosis of acute pancreatitis. Which region will most likely be painful for this client? A. Periumbilical pain migrating to the right lower quadrant B. Right upper quadrant pain that radiates to the right shoulder C. Right flank pain that radiates to the groin D. Epigastric pain that radiates to the back

D. Epigastric pain that radiates to the back

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? Reposition the client every 2 hours. Withhold oral feedings for the client. Monitor pulse oximetry every hour. Instruct the client to avoid coughing.

Reposition the client every 2 hours.

A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is most appropriate for a client with this diagnosis? Limiting I.V. fluids, as ordered, to decrease cardiac workload Withholding all oral intake, as ordered, to decrease pancreatic secretions Keeping the client supine to increase comfort Administering meperidine, as ordered, to relieve severe pain

Withholding all oral intake, as ordered, to decrease pancreatic secretions

A nurse is assessing a client with pancreatitis who is admitted with abdominal pain, nausea, and vomiting for two days. The client's vital signs are T 100.8°F, blood pressure 88/42 mmHg, heart rate 120/min, and respirations 30/min. The client's pulse oximeter shows an oxygen saturation of 87%. Which of the following does the nurse know may be affecting the accuracy of the client's pulse oximetry reading? A. Increased body temperature B. Tachypnea C. Tachycardia D. Hypotension

D. Hypotension

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired? Carbohydrate digestion Protein synthesis Protein digestion Fat digestion

Carbohydrate digestion

A nurse is completing a pain assessment of a client who has acute pancreatitis. Which of the following findings should the nurse expect? A. Pain in the right upper quadrant radiating to the right shoulder B. Report of pain being worse when sitting upright C. Pain is intermittent D. Epigastric pain radiating to the left shoulder

D. Epigastric pain radiating to the left shoulder

A client with acute pancreatitis is experiencing severe pain from the disorder. The nurse determines that education about positioning to reduce pain was effective if the client avoids which action? Sitting up Lying flat Leaning forward Drawing the legs to the chest

Lying flat The pain of pancreatitis is aggravated by lying supine or walking. This is because the pancreas is located retroperitoneally, and the edema and inflammation will intensify the irritation of the posterior peritoneal wall with these positions or movements. Positions such as sitting up, leaning forward, and flexing the legs (especially the left leg) will alleviate some of the pain associated with pancreatitis. The fetal position (with the legs drawn up to the chest) may decrease the abdominal pain of pancreatitis.

The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis? Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. Pancreatitis can atrophy the diaphragm and alter the breathing pattern. Pancreatitis can elevate the diaphragm and alter the breathing pattern. Pancreatitis causes alterations to hemoglobin, impairing oxygenation.

Pancreatitis can elevate the diaphragm and alter the breathing pattern.

The nurse is caring for a hospitalized client with pancreatitis. Which findings should the nurse look for and expect to note when reviewing the laboratory results? Select all that apply. Elevated lipase level Elevated lactase level Elevated trypsin level Elevated amylase level Elevated sucrase level

Elevated lipase level Elevated trypsin level Elevated amylase level

A nurse is caring for a client with cirrhosis and portal hypertension. The nurse understands that which of the following is a serious complication of portal hypertension? A. Hemorrhage from esophageal varices B. Perforation of the duodenum C. Intestinal obstruction D. Liver abscess

A. Hemorrhage from esophageal varices

The nurse is caring for a client with portal hypertension. Which of the following are likely to occur with the client's condition? (Select all that apply) A. Esophageal varices B. Thrombophlebitis C. Encephalopathy D. Ascites E. Bone disease

A. Esophageal varices C. Encephalopathy D. Ascites

When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.) Assisting the patient into the prone position Administering prophylactic antibiotics Encouraging bed rest to decrease the metabolic rate Withholding oral feedings to limit the release of secretin Administering parenteral opioid analgesics as ordered

Encouraging bed rest to decrease the metabolic rate Withholding oral feedings to limit the release of secretin Administering parenteral opioid analgesics as ordered

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? Encouraging frequent visits from family and friends Positioning the client on the side with the knees flexed Administering an analgesic once per shift, as ordered, to prevent drug addiction Administering frequent oral feedings

Positioning the client on the side with the knees flexed The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and ordered, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.

The nurse is charting findings from a client with cirrhosis. Which of the following findings are specifically related to the client's diagnosis? (Select all that apply) A. Anemia B. Hypoglycemia C. Bruising D. Gynecomastia E. Bradycardia

A. Anemia C. Bruising D. Gynecomastia

A nurse is caring for an elderly client admitted with acute pancreatitis who has a new prescription for intravenous infusion of normal saline. Which of the following statements are true concerning IV therapy in this client (select all that apply)? A. Older adults often have thicker veins, so it is usually more difficult to place an IV line. B. Older adults may have an increased risk of hypervolemia due to decreased cardiac and renal function. C. A 30-45 degree angle is recommended when placing an intravenous catheter since older adults have deeper veins. D. Use of an infusion pump is recommended for older individuals, even when they have dementia. E. Increased tourniquet pressure is recommended since it is often difficult to access an appropriate vein in an older person.

B. Older adults may have an increased risk of hypervolemia due to decreased cardiac and renal function. . D. Use of an infusion pump is recommended for older individuals, even when they have dementia

A nurse is assessing a client in the emergency department who presented with epigastric pain and nausea. The client has a bluish discoloration around the umbilicus. Which of the following is the most appropriate initial nursing action? A. Complete a head-to-toe assessment B. Place a nasogastric tube C. Notify the healthcare provider D. Establish IV access

C. Notify the healthcare provider A bluish discoloration around the umbilicus is known as Cullen's sign. It reflects pancreatic necrosis or intraabdominal bleeding, typically in clients with pancreatitis. The healthcare provider should be notified.

The nurse is caring for a client with biliary obstruction. The nurse interprets that obstruction of which passage is related to the client's condition? Cystic duct Liver canaliculi Common bile duct Right hepatic duct

Cystic duct

A nurse is caring for a client with jaundice and epigastric pain who is undergoing an evaluation for possible pancreatic carcinoma. The client asks the nurse how the diagnosis is made. Which of the following tests is most likely to give an accurate diagnosis? A. Pancreatic ultrasound B. CT scan C. Serum amylase D. Endoscopic ultrasound with fine-needle aspiration biopsy

D. Endoscopic ultrasound with fine-needle aspiration biopsy

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? Frequent vomiting, leading to loss of fluid volume High glucose concentration in the blood Acetone in the urine Dry mouth, which makes the client thirsty

Frequent vomiting, leading to loss of fluid volume

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? MODS Pancreatic necrosis Shock Tetany

Pancreatic necrosis

A nurse cares for a client with interstitial pancreatitis. What client teaching will the nurse include when planning care for the client? "Inflammation spreads to the surrounding glands." "Normal function returns after about 2 weeks." "Inflammation is confined to only the pancreas." "Tissue necrosis occurs within the pancreas."

"Inflammation is confined to only the pancreas."

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? "Maintain a high-sodium, high-calorie diet." "Maintain a high-fat diet and drink at least 3 L of fluid a day." "Maintain a high-fat, high-carbohydrate diet." "Maintain a high-carbohydrate, low-fat diet."

"Maintain a high-carbohydrate, low-fat diet."

An ultrasound examination of the gallbladder is scheduled for a client with a suspected diagnosis of cholecystitis. Correct instructions about the procedure should include which statement made by the nurse? "This procedure may cause discomfort." "This test requires that you lie still for short intervals." "This procedure is preceded by the administration of oral tablets." "This procedure requires that you not eat or drink anything for 24 hours before the test."

"This test requires that you lie still for short intervals."

A nurse is admitting a client who has pancreatitis resulting from chronic alcohol use. Which of the following screening tools should the nurse use to determine if the client is at risk for developing delirium tremens? A. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-AR) B. Michigan Alcoholism Screening Test (MAST) C. The CAGE Questionnaire D. Alcohol Use Disorders Identification Test (AUDIT)

A. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-AR)

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? Maintaining nothing-by-mouth (NPO) status Placing the client in a semi-Fowler's position Administering morphine I.V. as ordered Providing mouth care

Administering morphine I.V. as ordered

A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis? Malnutrition and acute pancreatitis Acute hepatitis and alcohol consumption Caffeine consumption and acute pancreatitis Alcohol consumption and smoking

Alcohol consumption and smoking

A nurse receives laboratory results for a client with acute pancreatitis. Which of the following lab values should the nurse prioritize to report to the healthcare provider ? A. Lipase 200 U/L B. Calcium 7.5 mg/dL C. Amylase 250 U/L D. Albumin 3.3 g/dL

B. Calcium 7.5 mg/dL Calcium is vital for cardiac function, neural transmission, blood clotting, and muscle contractility. Decreased levels of calcium occur with acute pancreatitis and can remain low for 7 to 10 days following the onset of the disorder. Manifestations of hypocalcemia include tetany, paresthesia, muscle cramps, increased peristalsis, diarrhea, and cardiovascular changes. The greatest risk to the client is ECG changes and hypotension from hypocalcemia. Therefore, the client's calcium level is the priority finding for the nurse to report to the provider

A client has a tumor of the head of the pancreas. What clinical manifestations will the nurse assess? Select all that apply. Jaundice Clay-colored stools Persistent hiccups Weight gain Dark urine

Clay-colored stools Dark urine Jaundice

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

Dysfunction of the pancreatic islet cells

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? Decreased white blood cell count Elevated urine amylase levels Decreased liver enzyme levels Increased serum calcium levels

Elevated urine amylase levels

When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.) Encouraging bed rest to decrease the metabolic rate Administering parenteral opioid analgesics as ordered Administering prophylactic antibiotics Assisting the patient into the prone position Withholding oral feedings to limit the release of secretin

Encouraging bed rest to decrease the metabolic rate Withholding oral feedings to limit the release of secretin Administering parenteral opioid analgesics as ordered

A nurse cares for a client with a disorder of the endocrine function of the pancreas. Which hormones or enzymes may be impacted by this disorder? Select all that apply. Glucagon Somatostatin Lipase Amylase Insulin

Glucagon Somatostatin Insulin

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? Red Green Black Gray

Gray

The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? High-carbohydrate, low-protein, low-fat diet Low-carbohydrate, high-potassium diet High-carbohydrate, high-protein, low-fat diet Low-sodium, high-potassium, low-fat diet

High-carbohydrate, low-protein, low-fat diet

A nurse is caring for a client who was admitted with pain, tenderness, and rigidity of the upper right abdomen, suggesting a gall bladder issue. The client has also been experiencing nausea and vomiting for the past 3 days. The admitting service is planning for tests to be conducted in the morning. Complete the table of diagnostics by choosing from the list of implications for testing. Laboratory Assessments- . Ultrasonography Cholescintigraphy

Laboratory Assessments-Cholesterol is elevated in biliary obstruction. Ultrasonography- It is used to visualize calculi in the gallbladder. Cholescintigraphy-The radioactive dye allows for visualization of the biliary tract.

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? Carry out wound care as prescribed. Withhold oral feedings. Maintain the client in a semi-Fowler's position. Administer enteral or parenteral nutrition.

Maintain the client in a semi-Fowler's position.

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

Measure blood glucose concentration every 4 to 6 hours

The nurse is assessing a client with liver disease for signs and symptoms of low albumin. Which sign or symptom should the nurse expect to note? Weight loss Peripheral edema Capillary refill of 5 seconds Bleeding from previous puncture sites

Peripheral edema Albumin is responsible for maintaining the osmolality of the blood. When the albumin level is low, osmotic pressure is decreased, which in turn can lead to peripheral edema.

The nurse is caring for a client with acute pancreatitis. Which medications should the nurse expect to be prescribed for treatment of this problem? Select all that apply. Insulin Morphine Dicyclomine Pancrelipase Pantoprazole Acetazolamide

Morphine Dicyclomine Pantoprazole Acetazolamide Medications used to treat acute pancreatitis include pain medications such as morphine, antispasmodics such as dicyclomine, proton pump inhibitors such as pantoprazole, and acetazolamide to decrease the volume and bicarbonate concentration of pancreatic secretions. Insulin is used in chronic pancreatitis to treat diabetes mellitus or hyperglycemia if needed, and pancreatic enzyme products are used for replacement of pancreatic enzymes.

A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does the nurse anticipate to note as a result of increased abdominal pressure? Select all that apply. Orthopnea and dyspnea Petechiae and ecchymosis Inguinal or umbilical hernia Poor body posture and balance Abdominal distention and tenderness

Orthopnea and dyspnea Petechiae and ecchymosis Inguinal or umbilical hernia Abdominal distention and tenderness

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? Adventitious breath sounds and hypertension Presence of easy bruising and bradycardia Pain with abdominal distention and hypotension Presence of blood in the client's stool and recent hypertension

Pain with abdominal distention and hypotension

Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? Allowing a clear liquid diet during the acute phase Administering oral analgesics around the clock Maintaining a high-Fowler's position Providing intensive insulin therapy

Providing intensive insulin therapy

A client with gallstones is diagnosed with acute pancreatitis and is requesting information about the physiology of the gallbladder. Which information will the nurse include about the function of this organ? Digests carbohydrates in the jejunum Releases bile in response to cholecystokinin Serves as a storage unit for glucagon Controls the flow of trypsin to digest proteins

Releases bile in response to cholecystokinin

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? Preventing fluid volume overload Teaching about the disease and its treatment Relieving abdominal pain Maintaining adequate nutritional status

Relieving abdominal pain

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? Providing the client with plenty of P.O. fluids Limiting I.V. fluid intake according to the physician's order Reserving a site for a peripherally inserted central catheter (PICC) Providing generous servings at mealtime

Reserving a site for a peripherally inserted central catheter (PICC) Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve a site for placement of a PICC, which enables the client to receive long-term total parenteral nutrition. Clients in the acute stages of pancreatitis also require large volumes of I.V. fluids to compensate for fluid loss.

A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis? Fibrosis and atrophy of the pancreatic gland Self-digestion of the pancreas by its own proteolytic enzymes Calcification of the pancreatic duct, leading to its blockage Use of loop diuretics to increase the incidence of pancreatitis

Self-digestion of the pancreas by its own proteolytic enzymes

The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. What does the nurse expect was the reason the patient came to the hospital? Fever Severe abdominal pain Jaundice Mental agitation

Severe abdominal pain

A client recovering from a cholecystectomy has decreased breath sounds bilaterally in the lower lobes. Which action(s) will the nurse take to improve the client's respiratory function? Select all that apply. Use the incentive spirometer as instructed. Raise the head of the bed. Assist to ambulate as prescribed. Splint the affected area. Deep breathe and cough every hour.

Splint the affected area. Raise the head of the bed. Assist to ambulate as prescribed. Deep breathe and cough every hour. Use the incentive spirometer as instructed.

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 board-like and no bowel sounds are detected. What is the major concern for this patient? The patient has developed renal failure. The patient is developing a paralytic ileus. The patient requires more pain medication. The patient has developed peritonitis.

The patient has developed peritonitis.

A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for?

Transjugular intrahepatic portosystemic shunting (TIPS) A TIPS procedure (see Fig. 49-8) is indicated for the treatment of an acute episode of uncontrolled variceal bleeding refractory to pharmacologic or endoscopic therapy. In 10% to 20% of patients for whom urgent band ligation or sclerotherapy and medications are not successful in eradicating bleeding, a TIPS procedure can effectively control acute variceal hemorrhage by rapidly lowering portal pressure.

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? Diarrhea Weight loss Fatigue Hypertension

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.

A client is experiencing blockage of the common bile duct. Which food selection made by the client indicates the need for further teaching? Rice Whole milk Broiled fish Baked chicken

Whole milk

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? decompression gavage instillation lavage

decompression

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

cannot tolerate high-glucose concentration.

Which foods should be avoided following acute gallbladder inflammation? Cooked fruits Mashed potatoes Cheese Coffee

cheese The client should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the client that fatty foods may induce an episode of cholecystitis. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-forming vegetables, bread, coffee, or tea may be consumed as tolerated.

The nurse has given instructions to a client who has just been prescribed cholestyramine. Which statement by the client indicates a need for further instruction? "I will continue taking vitamin supplements." "This medication will help lower my cholesterol." "This medication should only be taken with water." "A high-fiber diet is important while taking this medication."

"This medication should only be taken with water." Cholestyramine is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption.

A nurse is conducting an in-service for staff about nutritional management for a client who has acute pancreatitis. Which of the following statements by the staff indicates an understanding of the teaching? (Select all that apply.) A. "The client should be instructed to eat small, frequent meals." B. "Easy-to-digest foods with limited spice are better tolerated." C. "Skim milk instead of whole milk, should be used when cooking." D. "The client should be instructed to drink coffee to stimulate bowel function." E. "The client should limit alcohol intake to two drinks per day."

A. "The client should be instructed to eat small, frequent meals." B. "Easy-to-digest foods with limited spice are better tolerated." C. "Skim milk instead of whole milk, should be used when cooking.

A nurse is caring for a client with cirrhosis of the liver who has a prescription for intravenous albumin. The client's serum albumin level is 1.3 g/dL. Which of the following findings associated with hypoalbuminemia should the nurse anticipate when assessing this client? A. Ascites B. Altered mental status C. Excess body hair D. Easy bruising

A. Ascites Albumin is a large protein that remains in the vascular compartment and maintains the intravascular oncotic pressure, which pulls water into the blood vessels. Without sufficient albumin, fluid leaks out of the intravascular spaces into the interstitial fluids, causing ascites, and pitting edema. Periorbital edema may also be seen as a result of hypoalbuminemia. Normal albumin ranges from 3.5-5.0 g/dL.

A client is admitted to the hospital for acute gastritis and ascites secondary to chronic alcohol use disorder and cirrhosis. It is most important for the nurse to assess this client for: A. Blood in the stool B. Food intolerances C. Complaints of nausea D. Hourly urine output

A. Blood in the stool

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

Assisting the client to turn, cough, and deep breathe every 2 hours Explanation: 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 nurse is monitoring a client with cirrhosis of the liver for signs of hepatic encephalopathy. Which assessment finding would the nurse note as an early sign of hepatic encephalopathy? Restlessness Presence of asterixis Complaints of fatigue Decreased serum ammonia levels

Asterixis is a flapping tremor of the hand that is an early sign of hepatic encephalopathy. The exact cause of this disorder is not known, but abnormal ammonia metabolism may be implicated. Increased serum ammonia levels are thought to interfere with normal cerebral metabolism. Tremors and drowsiness also would be noted.

A nurse is assessing a client who is in the advanced stage of chronic liver disease. The nurse should identify which of the following findings as an indication the client has developed hepatic encephalopathy? (Select all that apply.) A. Anorexia B. Change in orientation C. Asterixis D. Ascites E. Fetor hepaticus

B. Change in orientation C. Asterixis E. Fetor hepaticus

A client with acute pancreatitis is admitted with nausea, vomiting, and epigastric pain. Assessment reveals heart rate of 110 beats per minute, a temperature of 100° Farenheit, and elevated serum amylase and lipase levels. Which of the following interventions does the nurse anticipate? (Select all that apply.) A. Trendelenburg position B. IV hydration with isotonic crystalloid solution C. High-fat diet D. IV opioid analgesic

B. IV hydration with isotonic crystalloid solution D. IV opioid analgesic

A very ill client with acute cholecystitis is scheduled for surgery. The surgeon plans to create an incision in the common bile duct to remove stones. The nurse correctly documents this surgery in the electronic medical record using which term? Cholecystectomy Choledochoduodenostomy Cholecystostomy Choledochostomy

Choledochostomy

A nurse is assisting a physician with performing the procedure illustrated (paracentesis). Which of the following nursing interventions is most appropriate during this procedure? A. Monitor the client while he is under anesthesia B. Ensure that the client has a full bladder before starting C. Measure the size of the liver prior to starting D. Monitor for hypovolemia during the procedure

D. Monitor for hypovolemia during the procedure The client is undergoing an abdominal paracentesis to remove excess fluid from the abdomen. During this procedure, the nurse is responsible for assisting the physician as well as reassuring the client, as the client will be awake and may feel some pressure in the abdomen. The nurse should have the client empty his bladder prior to starting the procedure and should monitor for signs of hypovolemia, as rapid removal of significant amounts of fluid could cause a drop in intravascular volume.

A nurse is assessing a client who has acute pancreatitis. Which of the following actions should the nurse take to assess for the presence of Turner's sign? A. Tap lightly at the costovertebral margin on the client's back. B. Auscultate the posterior lung fields. C. Inspect the skin around the umbilicus. D. Observe for the presence of ecchymosis on the client's flank

D. Observe for the presence of ecchymosis on the client's flank

A nurse is caring for a client with cirrhosis of the liver with ascites. The nurse knows that ascites is caused by which of the following? A. Reduced production of coagulation factors B. Increased albumin synthesis C. Increased ammonia D. Portal hypertension

D. Portal hypertension Ascites refers to the accumulation of fluid in the abdominal cavity. Both ascites and varices are caused by portal hypertension. Portal hypertension refers to increased pressure in the portal vein and results from changes in the circulation of the liver after scar tissue formation. In addition to increased hydrostatic pressure in the portal vein, decreased plasma oncotic pressure also contributes to ascites. The liver is the site of synthesis of albumin and other important proteins. Reduction of serum albumin creates third spacing, resulting in ascites.

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? ERCP CT Ultrasound MRI

ERCP

A nurse has admitted a client suspected of having acute pancreatitis. The nurse knows that mild acute pancreatitis is characterized by: Pleural effusion Sepsis Edema and inflammation Disseminated intravascular coagulopathy

Edema and inflammation

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? Liver enzyme changes Urinary output changes Electrocardiogram changes Electrolytes level changes

Electrocardiogram changes

The nurse is reviewing the results of serum laboratory studies for a client admitted for suspected hepatitis. Which laboratory finding is most associated with hepatitis, requiring the nurse to contact the primary health care provider? Elevated serum bilirubin level Below normal hemoglobin concentration Elevated blood urea nitrogen (BUN) level Elevated erythrocyte sedimentation rate (ESR)

Elevated serum bilirubin level

The nurse is caring for a client with suspected hepatitis. What diagnostic test results will assist in confirming this client's diagnosis? Select all that apply. Leukopenia Elevated hemoglobin Elevated liver enzymes Elevated serum bilirubin level Elevated blood urea nitrogen (BUN) Elevated serum erythrocyte sedimentation rate (ESR)

Leukopenia Elevated liver enzymes Elevated serum bilirubin level Elevated serum erythrocyte sedimentation rate (ESR)

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

Light-colored urine

he nurse has been caring for a client who required a Sengstaken-Blakemore tube because other treatment measures for esophageal varices were unsuccessful. The primary health care provider (PHCP) arrives on the nursing unit and deflates the esophageal balloon. Which assessment finding by the nurse is the most important and should be reported to the PHCP immediately? Hematemesis Bloody diarrhea Swelling of the abdomen An elevated temperature and a rise in blood pressure

hematemesis A Sengstaken-Blakemore tube may be inserted in a client with a diagnosis of cirrhosis with bleeding esophageal varices. It has both an esophageal and a gastric balloon. The esophageal balloon exerts pressure on the ruptured esophageal varices and stops the bleeding. The pressure of the esophageal balloon is released at intervals to decrease the risk of trauma to esophageal tissues, including esophageal rupture or necrosis. When the balloon is deflated, the client may begin to bleed again from the esophageal varices, manifested as vomiting of blood (hematemesis).