Liver/Pancreas

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

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

The physician orders a patient with pancreatitis to take a pancreatic enzyme. What assessment finding demonstrates the pancreatic enzymes are working properly? A. Abdominal girth is decreased B. Skin turgor is less than 2 seconds C. Blood glucose is 250 D. Stools appear formed and solid

D. Stools appear formed and solid Pancreatic enzymes help the body break down carbs, proteins, and fats because the body is not sufficiently producing digestive enzymes anymore. Hence, the stool will not appear as oily or greasy (decrease in steatorrhea) but appear solid and formed.

Select-ALL-that-apply: In the pancreas, the acinar cells release: A. Amylase B. Somatostatin C. Lipase D. Protease

A. Amylase C. Lipase D. Protease

While assisting a patient with chronic pancreatitis to the bathroom, you note the patient's stool to be oily/greasy in appearance. In your documentation you note this as: A. Steatorrhea B. Melena C. Currant D. Hematochezia

A. Steatorrhea

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply: A. Increase albumin levels B. Ascites C. Splenomegaly D. Fluid volume deficient E. Esophageal varices

B. Ascites C. Splenomegaly E. Esophageal varices Portal Hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experience ascites, enlarged spleen "splenomegaly", and esophageal varices etc.

Nurse Farrah is providing care for Kristoff who has jaundice. Which statement indicates that the nurse understands the rationale for instituting skin care measures for the client? A "Jaundice is associated with pressure ulcer formation." B "Jaundice impairs urea production, which produces pruritus." C "Jaundice produces pruritus due to impaired bile acid excretion." D "Jaundice leads to decreased tissue perfusion and subsequent breakdown."

C "Jaundice produces pruritus due to impaired bile acid excretion." Jaundice is a symptom characterized by increased bilirubin concentration in the blood. Bile acid excretion is impaired, increasing the bile acids in the skin and causing pruritus. Jaundice is not associated with pressure ulcer formation. However, edema and hypoalbuminemia are. Jaundice itself does not impair urea production or lead to decreased tissue perfusion.

A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed with ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering diuretic therapy, which nursing action would be most effective in ensuring safe care? A Measuring serum potassium for hyperkalemia B Assessing the client for hypervolemia C Measuring the client's weight weekly D Documenting precise intake and output

D Documenting precise intake and output For the client with ascites receiving diuretic therapy, careful intake and output measurement is essential for safe diuretic therapy. Diuretics lead to fluid losses, which if not monitored closely and documented, could place the client at risk for serious fluid and electrolyte imbalances. Hypokalemia, not hyperkalemia, commonly occurs with diuretic therapy. Because urine output increases, a client should be assessed for hypovolemia, not hypervolemia. Weights are also an accurate indicator of fluid balance. However, for this client, weights should be obtained daily, not weekly.

A patient is admitted to the ER with the following signs and symptoms: very painful mid-epigastric pain felt in the back, elevated glucose, fever, and vomiting. During the head-to-toe assessment, you notice bluish discoloration around the belly button. As the nurse, you know this is called? A. Grey-Turner's Sign B. McBurney's Sign C. Homan's Sign D. Cullen's Sign

D. Cullen's Sign This is known as Cullen's Sign. It represents retroperitoneal bleeding from the leakage of digestive enzymes from the inflamed pancreas into the surrounding tissues which is causing bleeding and it is leaking down to umbilicus tissue. Remember the C in Cullen for "circle" and the belly button forms a circle. The patient can also have Grey-Turner's Sign which is a bluish discoloration at the flanks (side of the abdomen). Remember this by TURNER ("turn her" over on her side) which is where the bluish discoloration will be.

You're caring for a 45 year old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are: A. High cholesterol and alcohol abuse B. History of diabetes and smoking C. Pancreatic cancer and obesity D. Gallstones and alcohol abuse

D. Gallstones and alcohol abuse

After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take (select all that apply)? a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. c. Teach about α-interferon therapy. d. Give hepatitis B immune globulin. e. Teach about choices for oral antiviral therapy.

a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. d. Give hepatitis B immune globulin. The recommendations for hepatitis B exposure include both vaccination and immune globulin administration. In addition, baseline testing for hepatitis B antibodies will be needed. Interferon and oral antivirals are not used for hepatitis B prophylaxis

After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a."I cannot drink any alcohol at all anymore." b."I need to avoid protein in my diet." c."I should not take over-the-counter medications." d."I should eat small, frequent, balanced meals."

b."I need to avoid protein in my diet." Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.

Which focused data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis? a. Hemoglobin c. Activity level b. Temperature d. Albumin level

d. Albumin level The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. The other parameters are not directly associated with the patient's edema.

A patient who received treatment for pancreatitis is being discharged home. You're providing diet teaching to the patient. Which statement by the patient requires immediate re-education about the diet restrictions? A. "It will be hard but I will eat a diet low in fat and avoid greasy foods." B. "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week." C. "I will concentrate on eating complex carbohydrates rather than refined carbohydrates." D. "I will purchase foods that are high in protein."

B. "It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week." A patient with pancreatitis should AVOID any amount of alcohol because of its effects on the pancreas. Remember alcohol is a cause of both acute and chronic pancreatitis. All the other options are correct.

Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis? a. The patient is alert and oriented. b. The patient denies nausea or anorexia. c. The patient's bilirubin level decreases. d. The patient has at least one stool daily.

a. The patient is alert and oriented. Lactulose is used to lower ammonia levels and prevent encephalopathy.

A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider? a.Asterixis and lethargy c.Elevated total bilirubin level b.Jaundiced sclera and skin d.Liver 3 cm below costal margin

a.Asterixis and lethargy The patient's findings of asterixis and lethargy are consistent with grade 2 hepatic encephalopathy. Patients with acute liver failure can deteriorate rapidly from grade 1 or 2 to grade 3 or 4 hepatic encephalopathy and need early transfer to a transplant center. The other findings are typical of patients with hepatic failure and would be reported but would not indicate a need for an immediate change in the therapeutic plan.

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

a.maintaining normal respiratory function.

The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern? a.The patient complains of right upper-quadrant pain with palpation. b.The patient's hands flap back and forth when the arms are extended. c.The patient has ascites and a 2-kg weight gain from the previous day. d.The patient's abdominal skin has multiple spider-shaped blood vessels.

b. The patient's hands flap back and forth when the arms are extended. Asterixis indicates hepatic encephalopathy.

Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? a.Request that the patient stand on one foot. b.Ask the patient to extend both arms forward. c.Request that the patient walk with eyes closed. d.Ask the patient to perform the Valsalva maneuver.

b.Ask the patient to extend both arms forward. Extending the arms allows the nurse to check for asterixis, a classic sign of hepatic encephalopathy. The other tests might also be done as part of the neurologic assessment but would not be diagnostic for hepatic encephalopathy.

A nurse cares for a client who is scheduled for a paracentesis. Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)? a.Have the client sign the informed consent form. b.Assist the client to void before the procedure. c.Help the client lie flat in bed on the right side. d.Get the client into a chair after the procedure.

b.Assist the client to void before the procedure. For safety, the client should void just before a paracentesis. The nurse or the provider should have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the side of the bed and leaning over the bedside table. The client will be on bedrest after the procedure.

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

b.The patient's stools are tan colored. Tan or gray stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a patient with this diagnosis, although the nurse would also report the other assessment information to the health care provider.

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

c. Amylase Amylase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be useful in evaluating whether the prescribed therapies have been effective.

Which topic is most important to include in patient teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis? a. Taking lactulose c. Avoiding alcohol ingestion b. Maintaining good nutrition d. Using vitamin B supplements

c. Avoiding alcohol ingestion The disease progression can be stopped or reversed by alcohol abstinence. The other interventions may be used when cirrhosis becomes more severe to decrease symptoms or complications, but the priority for this patient is to stop the progression of the disease.

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

c.Muscle twitching and finger numbness

A nurse is considering which patient to admit to the same room as a patient who had a liver transplant 3 weeks ago and is now hospitalized with acute rejection. Which patient would be the best choice? a. Patient who is receiving chemotherapy for liver cancer b. Patient who is receiving treatment for acute hepatitis c. Patient who has a wound infection after cholecystectomy d. Patient who requires pain management for chronic pancreatitis

d. Patient who requires pain management for chronic pancreatitis The patient with chronic pancreatitis does not present an infection risk to the immunosuppressed patient who had a liver transplant. The other patients either are at risk for infection or currently have an infection, which will place the immunosuppressed patient at risk for infection.

A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first? a.Sedate the client to prevent tube dislodgement. b.Maintain balloon pressure at 15 and 20 mm Hg. c.Irrigate the gastric lumen with normal saline. d.Assess the client for airway patency.

d.Assess the client for airway patency. Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this treatment. The client should be sedated, balloon pressure should be maintained between 15 and 20 mm Hg, and the lumen can be irrigated with saline or tap water. However, these are not a higher priority than airway patency.

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

d.Fewer episodes of bleeding varices TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding from esophageal varices. Indirect bilirubin level and serum albumin levels are not affected by shunting procedures. TIPS will increase the risk for hepatic encephalopathy.

A patient is in end-stage liver failure. Which interventions should the nurse implement when addressing hepatic encephalopathy? (Select all that apply.) A Assessing the client's neurologic status every 2 hours B Monitoring the client's hemoglobin and hematocrit levels C Evaluating the client's serum ammonia level D Monitoring the client's handwriting daily E Preparing to insert an esophageal tamponade tube F Making sure the client's fingernails are short

A Assessing the client's neurologic status every 2 hours C Evaluating the client's serum ammonia level D Monitoring the client's handwriting daily Hepatic encephalopathy results from an increased ammonia level due to the liver's inability to covert ammonia to urea, which leads to neurologic dysfunction and possible brain damage. The nurse should monitor the client's neurologic status, serum ammonia level, and handwriting. Monitoring the client's hemoglobin and hematocrit levels and insertion of an esophageal tamponade tube address esophageal bleeding. Keeping fingernails short address jaundice.

For a client with hepatic cirrhosis who has altered clotting mechanisms, which intervention would be most important? A Allowing complete independence of mobility B Applying pressure to injection sites C Administering antibiotics as prescribed D Increasing nutritional intake

B Applying pressure to injection sites The client with cirrhosis who has altered clotting is at high risk for hemorrhage. Prolonged application of pressure to injection or bleeding sites is important.

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

B Counseling to stop alcohol consumption Chronic pancreatitis typically results from repeated episodes of acute pancreatitis. More than half of chronic pancreatitis cases are associated with alcoholism. Counseling to stop alcohol consumption would be the most helpful for the client. Dietary protein modification is not necessary for chronic pancreatitis. Daily exercise and liberalizing fluid intake would be helpful but not the most beneficial intervention.

A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic encephalopathy. Which of the following nursing interventions are appropriate to prevent skin breakdown? (Select all that apply.) A Range of motion every 4 hours B Turn and reposition every 2 hours C Abdominal and foot massages every 2 hours D Alternating air pressure mattress E Sit in chair for 30 minutes each shift

B Turn and reposition every 2 hours D Alternating air pressure mattress

When planning home care for a client with hepatitis A, which preventive measure should be emphasized to protect the client's family? A Keeping the client in complete isolation B Using good sanitation with dishes and shared bathrooms C Avoiding contact with blood-soiled clothing or dressing D Forbidding the sharing of needles or syringes

B Using good sanitation with dishes and shared bathrooms Hepatitis A is transmitted through the fecal oral route or from contaminated water or food. Measures to protect the family include good handwashing, personal hygiene and sanitation, and use of standard precautions. Complete isolation is not required. Avoiding contact with blood-soiled clothing or dressings or avoiding the sharing of needles or syringes are precautions needed to prevent transmission of hepatitis B.

A patient with acute pancreatitis is reporting excessive thirst, excessive voiding, and blurred vision. As the nurse, it is priority you? A. Reassure the patient this is normal with pancreatitis B. Check the patient's blood glucose C. Assist the patient with drinking a simple sugar drink like orange juice D. Provide a dark and calm environment

B. Check the patient's blood glucose patients with pancreatitis are at risk for hyperglycemia because their insulin production is inhibited.

Your patient with acute pancreatitis is scheduled for a test that will use a scope to assess the pancreas, bile ducts, and gallbladder. The patient asks you, "What is the name of the test I'm going for later today?" You tell the patient it is called: A. MRCP B. ERCP C. CT scan of the abdomen D. EGD

B. ERCP ERCP (Endoscopic Retrograde Cholangio-Pancreatography) is used to diagnosis and sometimes treat the causes of pancreatitis. It will assess the pancreas, bile ducts, and gallbladder. In addition, the doctor may be able to remove gallstones, dilate the blocked ducts with a stent or balloon, drain presenting cysts etc.

During a home health visit, you are assessing how a patient takes the prescribed pancreatic enzyme. The patient is unable to swallow the capsule whole, so they open the capsule and mix the beads inside the capsule with food/drink. Which food or drink is safe for the patient to mix the beads with? A. Pudding B. Ice cream C. Milk D. Applesauce

D. Applesauce The patient should mix the medications with acidic foods like applesauce. It is very important the patient does NOT use alkaline foods for mixing (like dairy products, pudding etc.) because they can damaged the enzyme

You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply: A. Frothy light-colored urine B. Dark brown urine C. Yellowing of the sclera D. Dark brown stool E. Jaundice of the skin F. Bluish mucous membranes

B. Dark brown urine C. Yellowing of the sclera E. Jaundice of the skin High bilirubin levels are because the hepatocytes are no longer able to properly conjugate the bilirubin because they are damaged. This causes bilirubin to leak into the blood and urine (rather than entering the bile and being excreted in the stool). Therefore, the bilirubin stays in the blood and will enter the urine. This will cause the patient to experience yellowing of the skin, sclera of the eyes, and mucous membranes ("jaundice") and have dark brown urine. The stools would be CLAY-COLORED not dark brown (remember bilirubin normally gives stool it brown color but it will be absent).

A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, "I do not want to take this medication because it causes diarrhea." How should the nurse respond? a."Diarrhea is expected; that's how your body gets rid of ammonia." b."You may take Kaopectate liquid daily for loose stools." c."Do not take any more of the medication until your stools firm up." d."We will need to send a stool specimen to the laboratory."

a."Diarrhea is expected; that's how your body gets rid of ammonia." The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse should not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.

A nurse plans care for a client who has hepatopulmonary syndrome. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a.Oxygen therapy b.Prone position c.Feet elevated on pillows d.Daily weights e.Physical therapy

a.Oxygen therapy c.Feet elevated on pillows d.Daily weights Care for a client who has hepatopulmonary syndrome should include oxygen therapy, the head of bed elevated at least 30 degrees or as high as the client wants to improve breathing, elevated feet to decrease dependent edema, and daily weights. There is no need to place the client in a prone position, on the client's stomach. Although physical therapy may be helpful to a client who has been hospitalized for several days, physical therapy is not an intervention specifically for hepatopulmonary syndrome.

A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a.Urine output via indwelling urinary catheter is 20 mL/hr b.Blood pressure increases from 110/58 to 120/62 mm Hg c.Respiratory rate decreases from 18 to 14 breaths/min d.A decrease in the client's weight by 6 kg

a.Urine output via indwelling urinary catheter is 20 mL/hr Rapid removal of ascetic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the client's weight to drop as fluid is removed. Six kilograms is less than 3 pounds and is expected.

A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder? (Select all that apply.) a.Elevated aspartate transaminase b.Elevated international normalized ratio (INR) c.Decreased serum globulin levels d.Decreased serum alkaline phosphatase e.Elevated serum ammonia f.Elevated prothrombin time (PT)

b.Elevated international normalized ratio (INR) e.Elevated serum ammonia f.Elevated prothrombin time (PT) Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the client's confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? a.Monitor intake and output. b.Provide a low-sodium diet. c.Increase oral fluid intake. d.Weigh the client daily.

b.Provide a low-sodium diet. A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.

During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first? a.A 40-yr-old patient with chronic pancreatitis who has gnawing abdominal pain b.A 58-yr-old patient who has compensated cirrhosis and is complaining of anorexia c.A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C) d.A 36-yr-old patient recovering from a laparoscopic cholecystectomy who has severe shoulder pain

c.A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C) This patient's history and fever suggest possible spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy. The clinical manifestations for the other patients are consistent with their diagnoses and do not indicate complications are occurring.

A patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective? a.The patient reports no chest pain. b.Blood pressure is 140/90 mm Hg. c.Stools test negative for occult blood. d.The apical pulse rate is 68 beats/minute.

c.Stools test negative for occult blood. Purpose of beta blocker therapy in this case is to decrease bleeding risk from varices.

A 45 year old male has cirrhosis. The patient reports concern about the development of enlarged breast tissue. You explain to the patient that this is happening because? A. The liver cells are removing too much estrogen from the body which causes the testicles to produce excessive amounts of estrogen, and this leads to gynecomastia. B. The liver is producing too much estrogen due to the damage to the liver cells, which causes the level to increase in the body, and this leads to gynecomastia. C. The liver cells are failing to recycle estrogen into testosterone, which leads to gynecomastia. D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.