AHS 6

Which instruction would the nurse provide to ensure drug safety in a patient who has been prescribed propantheline (Pro-Banthine) for spasms in the liver? "Take the drug only in the morning." "Avoid alcohol intake along with the drug." "Discontinue the drug if you develop chest pain." "Take an anti-emetic medication along with the drug." Rationale Drowsiness and confusion are side effects of using propantheline (Pro-Banthine). The patient is advised to avoid the use of central nervous system (CNS) depressants or alcohol when taking the drug. Spironolactone (Aldactone) is taken in the morning to avoid interference with sleep. Vasopressin (Pitressin) should be discontinued if chest pain develops. The patient is prescribed gemcitabine hydrochloride (Gemzar) with an antiemetic drug to control nausea and vomiting.

"Avoid alcohol intake along with the drug."

A patient in the clinic has been diagnosed with acute viral hepatitis caused by hepatitis B virus. The patient requests that the nurse not tell anyone about his infection. Which response by the nurse would be best? "By law, I have to notify all of your sexual partners." "By law, I have to notify your family." "By law, I have to notify the Centers for Disease Control and Prevention (CDC).!" 'By law, I have to notify all of your sexual partners and the CDC. Rationale The nurse should tell the patient that the law requires all cases of viral hepatitis to be reported to the CDC. Although the nurse cannot tell the patient's partners, the patient should be encouraged to inform the partners so that they may seek testing and treatment in timely fashion. Health information is protected by the Health Insurance Portability and Accountability Act (HIPAA) and is not to be released to any family unless the patient consented to tell his or her family.

"By law, I have to notify the Centers for Disease Control and Prevention (CDC).!"

Which instructions would the nurse give to a patient with acute pancreatitis during dietary teaching? Select all that apply. "Consume a low-fat diet." "Avoid consuming alcohol." "Avoid taking too much fluid." "Consume a high-protein diet." "Consume a low-carbohydrate diet." Rationale Consuming a low fat diet is essential in case of pancreatitis. Fats should be avoided because they stimulate the secretion of cholecystokinin, which then stimulates the pancreas. Alcohol is an irritant and must be avoided. A diet high in protein content is recommended. Fluid intake should be increased to prevent dehydration. Carbohydrates are less stimulating to the pancreas and are encouraged.

"Consume a low-fat diet." "Avoid consuming alcohol." "Consume a high-protein diet."

Which preventive measures would the nurse instruct to prevent common respiratory complications in a patient who underwent liver transplantation? Select all that apply. "Cough and deep breathe." "You should sneeze." "Breathe rapidly." "You should reposition frequently." "You should use the incentive spirometer." Rationale Common respiratory problems that occur after liver transplantation in a patient include pneumonia, atelectasis (collapsed lung), and pleural effusions. Have the patient use such measures as coughing, deep breathing, incentive spirometry, and repositioning to prevent these complications. Sneezing and rapid breathing do help prevent respiratory complications.

"Cough, and deep breathe." "You should reposition frequently." "You should use the incentive spirometer."

A patient suffering from cholelithiasis underwent a cholecystectomy. Which dietary advice would the nurse give this patient? Select all that apply. "Have a high-fiber diet." "Limit intake of water." "Resume your normal diet." "Have small, frequent meals." "Avoid fat or keep it to the minimum." Rationale Having a high-fiber diet helps in the smoother passage of stools and prevents constipation. Having small, frequent meals helps digestion and prevents nausea. Fats make it harder to digest, SO fat should be avoided. After cholecystectomy, it is essential that the patient take adequate intake of water, around 2500 to 3000 mL/day. The patient should not have the usual foods; modifications are needed to facilitate easy digestion of food in the absence of the gall bladder.

"Have a high-fiber diet." "Have small, frequent meals." "Avoid fat or keep it to the minimum."

A nurse who is providing education to a patient with cirrhosis knows the importance of preventing bleeding. Which instruction would be most important to prevent bleeding? "Change position in bed often." "Use a soft-bristled toothbrush." "Strictly follow the therapeutic diet provided." "Avoid the use of perfumed lotions and soaps." Rationale To prevent bleeding, the patient should use a soft-bristled toothbrush. The patient should also change position often, follow the therapeutic diet, and avoid use of perfumed lotions and soaps, but these instructions do not help the patient prevent bleeding.

"Use a soft-bristled toothbrush."

A patient with cirrhosis of the liver has ascites and is being prepared for a pal Grab screen area, would the nurse give the patient? "Fast overnight." "You should lie down during the procedure." "Avoid taking any fluids before paracentesis." "Void urine immediately before paracentesis." Rationale The nurse should instruct the patient to void prior to paracentesis to prevent accidental puncture of the bladder. During the procedure, the patient sits on the side of the bed or, is placed in high- Fowler's position. There is no need to keep the patient on NPO (nothing by mouth) status or to restrict fluid intake.

"Void urine immediately before paracentesis."

A patient with hepatitis A infection is being discharged from the hospital. Which instruction is most important for the nurse to include in the discharge teaching? "Avoid sharing razors or toothbrushes." "Wash hands carefully after bowel movements." "Avoid close contact with other family members." "Take acetaminophen every 4 hours, if fever persists." Rationale The mode of transmission of hepatitis A infection is the fecal-oral route. Therefore, it is very important to maintain personal and environmental hygiene. The nurse should teach the patient and the family members about washing hands after bowel movements and before eating to prevent outbreaks of hepatitis A viral infection. Not sharing toothbrushes and razors is a concern for the prevention of hepatitis B and C because it is transferred through blood contact. There is no need to isolate the patient with hepatitis A unless he or she is incontinent or maintains poor personal hygiene. Acetaminophen causes liver damage and should be avoided in hepatic viral infection.

"Wash hands carefully after bowel movements."

A nurse who is providing education to a patient newly diagnosed with liver cirrhosis discusses appropriate pain control at home. Which over-the-counter medication listed by the patient indicates a need for further education on appropriate pain medication choices? Aspirin (Ecotrin) Ibuprofen (Advil) Naproxen (Aleve) Acetaminophen (Tylenol) Rationale Acetaminophen (Tylenol) is hepatotoxic and should not be used in a patient with liver disease. Aspirin, ibuprofen, and naproxen should all be used with caution in a patient with liver disease.

Acetaminophen (Tylenol)

Grab screen area, OCR, and copy results to clipboard patient diagnosed with alcoholic cirrhosis of the liver. Which item written on the nursing Kardex would the licensed practical/vocational nurse (LPN/LVN) ask the registered nurse (RN) about before implementing? Folic acid supplement Acetaminophen prn pain Diphenhydramine prn itching High-calorie, low-fat, low-sodium diet Rationale Acetaminophen (Tylenol) is a known hepatotoxin and would be inappropriate and dangerous for this patient. A high-calorie, low-fat, low-sodium diet is appropriate. Also, a moderate high-protein diet would be encouraged as well, as long as liver failure is not imminent. Diphenhydramine (Benadryl) is safe to administer to the patient with hepatic cirrhosis. A folic acid supplement will help to improve nutritional deficiencies in the patient with hepatic cirrhosis. Vitamins may be administered as well.

Acetaminophen prn pain

Which condition does the nurse suspect in an adult patient whose aspartate aminotransferase (AST) level is 45 units/L? Hyperparathyroidism Cancer of the pancreas Acute hemolytic anemia Metastatic tumor in the bones Rationale AST is a liver enzyme whose normal range in adults is 0 to 35 units/L. In this patient, the AST level iS 45 units/L. An increase in AST levels indicates acute hemolytic anemia. Hyperparathyroidism can be suspected if the patient has elevated levels of alkaline phosphatase. Cancer of the pancreas can be suspected if the patient has elevated levels of gamma-glutamyl transpeptidase (GGT). Metastatic tumor in bones is suspected if the patient has elevated levels of alkaline phosphatase.

Acute hemolytic anemia

Grab screen area, OCR and copy results to aipbond er prescribes pancrelipase (Pancrease) to a patient with pancreatic insufficiency. Which factor does the nurse assess before administering the drug? Severity of skin integrity Electrolytes in the patient Renal function and urinary output Allergy to pork Rationale Pancrelipase (Pancrease) is a drug derived from pork; the nurse should, therefore, check whether the patient is allergic to pork. Skin integrity severity is assessed when the patient is administered cholestyramine (Questran). Electrolytes and serum creatinine levels have to be assessed in the patient after administration of spironolactone (Aldactone). Renal function is monitored after administration of neomycin (Mycifradin) and the urinary output is monitored after administration of vasopressin (Pitressin).

Allergy to pork

Which hematologic symptoms might be noted in a patient with cirrhosis of the liver? Select all that apply. Anemia Leukemia Leukopenia Polycythemia vera Thrombocytopenia Rationale Hematologic problems include thrombocytopenia, leukopenia, anemia, and coagulation disorders. Anemia caused by inadequate red blood cell (RBC) production and survival, poor diet, poor absorption of folic acid, and bleeding from varices. Anemia, leukopenia, and thrombocytopenia are also probably caused by the splenomegaly that results from the backup of blood from the portal vein into the spleen (portal hypertension). Overactivity of the enlarged spleen, results in increased removal of blood cells from circulation. Leukemia and polycythemia vera are not caused by cirrhosis.

Anemia Leukopenia Thrombocytopenia

A nurse is caring for a patient who underwent laparoscopic cholecystectomy 8 hours ago. The patient requests for help to get up and go the bathroom. Which nursing action is most therapeutic for the patient? Assist the patient to the bathroom. Obtain an order for a Foley catheter. Encourage the use of the bedside commode. Remind the patient that he or she is on complete bed rest, and offer a bedpan. Rationale Patients should ambulate by the first night postoperatively; therefore, the nurse should assist the patient to the bathroom. The patient is not on bed rest, so a bedpan is not necessary. A Foley catheter is not recommended for this patient. The patient should use a bedside commode if unable to ambulate safely to the bathroom

Assist the patient to the bathroom.

Jaundice is caused by an excess amount of which component in the bloodstream? Bilirubin Alkaline phosphatase Lactic dehydrogenase (LDH) Aspartate aminotransferase (AST) Rationale Jaundice causes yellow discoloration of body tissues because of an excess amount of bilirubin in the bloodstream. This abnormal assessment finding is recognized when total serum bilirubin exceeds 2.5 mg/dL. AST is elevated in myocardial infarction, hepatitis, liver disorders (cirrhosis, necrosis, tumor, hepatitis), acute pancreatitis, and hemolytic anemia; it does not result in jaundice. Alkaline phosphatase is elevated in biliary tract disorders, hepatic tumors, cirrhosis, primary and metastatic tumors, hyperparathyroidism, and bone disorders (fractures, tumors); it does not result in jaundice. Lactic dehydrogenase is elevated in myocardial infarction, pulmonary infarction, hepatic disease, pancreatitis, and skeletal muscle disease; it does not result in jaundice.

Bilirubin

Which complication is a patient with cirrhosis at risk for? Falls Bleeding Pneumonia Myocardial infarction Rationale Cirrhosis would make the patient unable to absorb vitamin K, which is an important component of the clotting cascade; a deficiency in vitamin K increases the risk of bleeding. The patient's risk of falls, pneumonia, and myocardial infarction are not increased as a result of decreased vitamin K.

Bleeding

A patient arrives in the emergency department complaining of severe abdominal pain in the right upper quadrant that began 2 hours ago, immediately after a large meal of fatty food. Which diagnosis does the nurse anticipate? Hepatitis Pancreatitis Cholecystitis Irritable bowel disease Rationale Sudden onset upper quadrant abdominal pain after a fatty meal is most likely cholecystitis caused by cholelithiasis. This patient is not likely to have hepatitis, pancreatitis, or irritable bowel syndrome.

Cholecystitis

Which drug does the nurse expect the health care provider to prescribe to a patient with acute pancreatitis to prevent stress ulcers? Ribavirin (Rebetol) Propranolol (Inderal) Cimetidine (Tagamet) Propantheline (Pro-Banthine) Rationale The patient with pancreatitis has reduced gastric pH, which may result in stress ulcers. To prevent this condition, the health care provider should prescribe an antacid to elevate the gastric pH. Antacids, such as cimetidine (Tagamet), are expected to be prescribed. Ribavirin (Rebetol) is used in the treatment of chronic hepatitis C infections. Propranolol (Inderal) reduces the risk of bleeding from nonbleeding esophageal varices. Propantheline (Pro-Banthine) helps decrease pancreatic activity in patients with pancreatitis.

Cimetidine (Tagamet)

Which drug would the nurse expect the health care provider to prescribe before initiating a liver transplantation to ensure a safe and successful surgery? Cyclosporine (Gengraf) Acetaminophen (Tylenol) Dimenhydrinate (Dramamine) Hydroxyzine pamoate (Vistaril) Rationale The most common complications in the recipient of a liver transplant include rejection of the new liver tissue and infection. The use of cyclosporine (Gengraf), an effective immunosuppressant drug, has been a major factor in improving the success rate of liver transplantation. Cyclosporine (Gengraf) does not cause bone marrow suppression and does not impede wound healing. Acetaminophen (Tylenol) is used to relieve pain and reduce fever in the patient. Dimenhydrinate (Dramamine) is an antiemetic drug given to patients with severe liver dysfunction. Hydroxyzine pamoate (Vistaril) is also an antiemetic; however, it is contraindicated in patients with liver dysfunction. Grab screen area, OCR and copy results to clipboard

Cyclosporine (Gengraf)

The nurse anticipates administering which medication to a patient immediately after liver transplantation? Lactulose (Enulose) Cyclosporine (Sandimmune) Acetaminophen (Tylenol) Hepatitis B vaccine Rationale Immediately after transplantation, the nurse should anticipate administering cyclosporine to help prevent transplant rejection. Acetaminophen is hepatotoxic and should not be administered after liver transplantation. Lactulose and hepatitis B vaccine are not necessary at this point.

Cyclosporine (Sandimmune)

A patient suffering from severe viral hepatitis is advised a liver function test by the health care provider. Which finding would the nurse expect in the patient's diagnostic report? Decreased direct bilirubin levels Decreased serum albumin levels Decreased alkaline phosphatase Decreased aspartate aminotransferase Rationale Hepatitis is characterized by inflammation of the liver, resulting in impairment of liver function. The liver is associated with the production of albumin, but because of impairment of its function, albumin levels are decreased. Decreased albumin levels are observed in the liver diagnostic reports of a hepatitis patient. Impaired liver function is also associated with increased bilirubin levels, which may further lead to jaundice. The alkaline phosphatase levels are increased due to blockage of their flow from the biliary tract and do not indicate hepatitis. Levels of aspartate aminotransferase are elevated if any organ has disease or injury.

Decreased serum albumin levels

Which drug does the nurse expect the health care provider to prescribe to reduce nausea in a patient with severe liver dysfunction? Dimenhydrinate (Dramamine) Hydroxyzine pamoate (Vistaril) Hydroxyzine hydrochloride (Atarax) Prochlorperazine maleate (Compazine) Rationale The metabolism of oral drugs takes place in the liver. Patients with liver dysfunction cannot clear the drug from their systems, and this would result in toxicity. Dimenhydrinate (Dramamine) has an easy first-pass metabolism and can be cleared from the system more effectively when compared to other antiemetic drugs. Hydroxyzine pamoate (Vistaril) is an antiemetic but is contraindicated in patients with liver dysfunction. Hydroxyzine hydrochloride (Atarax) is also an antiemetic, contraindicated in patients with liver dysfunction. Prochlorperazine maleate (Compazine) is another drug that reduces nausea but is contraindicated in patients with liver dysfunction.

Dimenhydrinate (Dramamine)

A patient with late-stage cirrhosis is experiencing nausea and vomiting. The nurse anticipates the provider to prescribe which medication to alleviate nausea and vomiting? Diphenhydramine (Benadryl) Hydroxyzine pamoate (Vistaril) Hydroxyzine hydrochloride (Atarax) Prochlorperazine maleate (Compazine) Rationale Diphenhydramine (Benadryl) or dimenhydrinate (Dramamine) may be prescribed for nausea and vomiting in the patient with cirrhosis. Hydroxyzine pamoate (Vistaril), hyd roxyzine hydrochloride (Atarax), and prochlorperazine maleate (Compazine) is contraindicated in patients with severe liver damage.

Diphenhydramine (Benadryl)

A nurse is caring for a patient scheduled for laparoscopic cholecystectomy. In the patient's chart, the nurse finds signed consent forms for laparoscopic cholecystectomy and open cholecystectomy. Which action should the nurse take? Cancel the surgery until the medical team is clear on the plan. Discard the open cholecystectomy consent form to prevent confusion. Call the health care provider immediately to rectify the situation. Do nothing. Both consent forms are necessary in case the surgical plan changes. Rationale A consent form for both the laparoscopic and open cholecystectomies should be signed and placed in the patient's chart in case the surgical plan must be changed during the operation. The nurse does not need to call the health care provider, cancel the surgery, or discard the open cholecystectomy consent form.

Do nothing. Both consent forms are necessary in case the surgical plan changes.

What complications are associated with cirrhosis of the liver? Select all that apply. Edema of feet Difficulty breathing Disorientation and lethargy Blood in the stools or black stools Severe pain in the chest and a cold sweat Rationale Complications of cirrhosis of the liver include peripheral edema, gastric varices, and hepatic encephalopathy. Peripheral edema presents itself as swelling/edema of feet. Hepatic encephalopathy presents as disorientation, altered mental status, sleep disturbances, and lethargy. Gastric varices bleed easily. This bleeding can be presented as blood in the vomitus or in the stool. Cirrhosis does not lead to pain in the chest, a cold sweat, or difficulty breathing.

Edema of feet Disorientation and lethargy Blood in the stools or black stools

Which nursing interventions are appropriate to prevent respiratory complications in a patient who has just undergone liver transplantation? Select all that apply. Encourage the patient to cough. Consider repositioning the patient. Encourage the patient to take deep breaths. Instruct the patient to walk around the bed. Administer cough suppressants to prevent coughing. Rationale The patient who has had a liver transplant requires highly skilled nursing care in the intensive care unit (ICU) or another specialized unit. To prevent respiratory complications, the patient should be encouraged to use such measures as coughing, repositioning, and deep breathing. The patient can be ambulated later, when the condition is stable. Administering cough suppressants would be counterproductive to recovery.

Encourage the patient to cough. Consider repositioning the patient. Encourage the patient to take deep breaths.

Which diagnostic test is preferred for visualizing the biliary tree in a patient with jaundice? Cholecystography Gallbladder ultrasonography Oral cholecystography (OCG) Intravenous cholangiography (IVC) Rationale The preferred diagnostic test for visualizing the biliary tree in a patient with jaundice is a gallbladder ultrasound. OCG is : method of visualizing the biliary tree, but it is ineffective in the patient with jaundice. IVC is a method of visualizing the biliary tree, but it is ineffective in the patient with jaundice. Cholecystography is another term for OCG.

Gallbladder ultrasonography

A nurse who is preparing to care for a patient diagnosed with cholecystitis knows the patient most likely also has which condition? Cirrhosis Gallstones Alcoholism Hypercholesterolemia Rationale Gallstones are the cause of cholecystitis in 90% of cases. Hypercholesterolemia may contribute to the formation of gallstones, but this is not always the case. Cirrhosis and alcoholism are not the primary cause of cholecystitis.

Gallstones

The nurse is caring for a patient with metastatic adenocarcinoma of the pancreas. Which drug does the nurse expect to find in the patient's prescription? Vasopressin (Pitressin) Cholestyramine (Questran) Spironolactone (Aldactone) Gemcitabine hydrochloride (Gemzar) Rationale Gemcitabine hydrochloride (Gemzar) is used to treat patients with metastatic adenocarcinoma of the pancreas. Vasopressin (Pitressin) is an antidiuretic drug, used to treat bleeding esophageal varices in patients. Cholestyramine (Questran) is used to relieve pruritus associated with elevated levels of bile acids. Spironolactone (Aldactone) is used to treat cirrhosis of the liver with ascites.

Gemcitabine hydrochloride (Gemzar)

Which food would be most appropriate for a patient who recently had a bout of acute pancreatitis? Select all that apply. Chips and salsa Eggs and bacon Coffee and Danish pastry Grilled chicken and a baked potato Reduced-fat cheese and whole-wheat crackers Rationale The optimal diet for a patient who has recently had pancreatitis is a bland, low-fat, high-protein, high-carbohydrate diet. The reduced-fat cheese and whole-wheat crackers and chicken and baked potato best meet these recommendations. Chips and salsa would not be the best choice because salsa is not considered a bland food. Eggs and bacon would not be a good choice; this is neither a bland nor a low-fat meal. Coffee and Danish pastry would not be the best choice because coffee is a gastric stimulant and the pastry is likely to be high in fat.

Grilled chicken and a baked potato Reduced fat cheese and whole-wheat crackers

A nurse is assisting with a paracentesis for a patient with ascites caused by cirrhosis. Which action should the nurse take first? Monitor for signs of syncope. Have the patient empty the bladder. Position patient in high-Fowler's position. Observe the site for bleeding or drainage. Rationale The patient should empty the bladder before the paracentesis to prevent puncture of the bladder. Then, the patient should be positioned sitting on the side of the bed or in high-Fowler's position. While the fluid is being removed, the nurse should monitor the patient for signs of syncope. After the procedure, the nurse should observe the dressing site for bleeding and drainage.

Have the patient empty the bladder.

During an assessment of a patient, the nurse finds asterixis, twitching of the extremities, and notices that the patient is displaying inappropriate behavior and disorientation. Which condition does the nurse suspect in this patient? Ascites Liver cirrhosis Esophageal varices Hepatic encephalopathy Rationale Hepatic encephalopathy is a type of brain damage caused by liver disease. The patient's signs and symptoms progress from inappropriate behavior, disorientation, asterixis, and twitching of the extremities. Symptoms of ascites include loss of appetite, nausea and vomiting, general weakness, and fatigue. Liver cirrhosis is characterized by dyspepsia, changes in bowel habits, gradual weight loss, ascites, enlarged spleen, malaise, nausea, jaundice, and ecchymoses. Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension. It may lead to bleeding in the esophagus if not treated, but it is not accompanied by such symptoms as asterixis, twitching of the extremities, inappropriate behavior, and disorientation.

Hepatic encephalopathy

Which form of hepatitis, with an incubation period of 10 to 40 days, is most common today? Hepatitis A Hepatitis B Hepatitis C Hepatitis D Rationale Hepatitis A is the most common form of hepatitis today. Formerly termed infectious hepatitis, it is a short-incubation virus (10-40 days). Hepatitis B is a long-incubation virus (28-160 days). Persons at risk for hepatitis B include health care workers, persons with high-risk lifestyles (drug users, tattoo recipients, homosexual men, and sex workers), infants born to mothers who are hepatitis B surface antigen (HBsAg) positive, hemodialysis patients, and persons sharing a household with a person infected with hepatitis B. Hepatitis C has an incubation period of 2 weeks to 6 months, commonly 6 to 9 weeks. Hepatitis D, also known as the delta virus, has an incubation period of 2 to 10 weeks. It causes hepatitis as coinfection with hepatitis B and may progress to cirrhosis and chronic hepatitis.

Hepatitis A

Which factors may lead to the development of ascites? Select all that apply. Diabetes mellitus Hyperaldosteronism Portal hypertension Decreased flow of hepatic lymph Decreased serum colloidal oncotic pressure Rationale Hyperaldosteronism or increased secretion of aldosterone causes ascites. Portal hypertension causes an increase in resistance to blood flow in the liver leading to ascites. When there is decreased serum colloidal oncotic pressure, there is impairment of synthesis of albumin and loss of albumin in the peritoneal cavity. It leads to ascites. Diabetes is a metabolic syndrome and does not cause ascites. Increased flow of hepatic lymph, not decreased flow, leads to ascites.

Hyperaldosteronism Portal hypertension Decreased serum colloidal oncotic pressure

A patient with asthma is using royal jelly for pancreatitis. Which parameter would the nurse monitor to ensure the patient's safety? Hypotension Hypokalemia Hypoglycemia Hypersensitivity Rationale Royal jelly (bee pollen complex) is used in treating pancreatitis. Hypersensitive reactions should be monitored in patients with asthma using royal jelly for pancreatitis. If the patient is allergic to royal jelly, it may lead to asthma attacks, anaphylaxis, and even death. Patients with pancreatitis are not at risk of hypotension, and royal jelly does not alter blood pressure. Hypoglycemia is not related to pancreatitis. Royal jelly has good glucose supplements and does not diminish glucose content. Neither pancreatitis nor royal jelly is associated with hypokalemia.

Hypersensitivity

A patient who underwent a cholecystectomy is now complaining of pain radiating to his right shoulder. Which causes may be responsible for this pain? Select all that apply. Myocardial infarction Pericarditis after surgery Gallstone left accidentally Irritation of the phrenic nerve Carbon dioxide used in surgery Rationale The carbon dioxide that is used to inflate the abdomen during surgery may not be released or absorbed by the body and can irritate the phrenic nerve and the diaphragm. This is the reason for breathing difficulty and the most common cause of shoulder pain after cholecystectomy. Other conditions, such as myocardial infarction, pericarditis after surgery, and a gallstone left in the gall bladder, may also cause shoulder pain but are less relevant in this situation.

Irritation of the phrenic nerve Carbon dioxide used in surgery

A patient with cancer of the head of the pancreas is admitted to the hospital. Which manifestations would the nurse expect to find in this patient? Select all that apply. Jaundice Itching and irritation of the skin Ulcers on the back and abdomen Swelling of the face and extremities Extreme pain in the upper abdomen that may radiate to the back Rationale Most often the head of the pancreas is involved and causes jaundice by compressing and obstructing the common bile duct. Pruritus is also a common symptom in cancer of the pancreas; hence, the patient may complain of itching and irritation of the skin. Abdominal pain in the midepigastric region or back occurs in many of the patients. Edema and ulcers are not common manifestations of pancreatic cancer.

Jaundice Itching and irritation of the skin Extreme pain in the upper abdomen that may radiate to the back

Which mechanism causes itching for a patient with intense pruritus? Ascites, which causes dry skin Poor diet, which causes pH imbalances of the skin Poor hygiene, which causes dead skin cells to build-up Jaundice, which causes the accumulation of bile salts under the skin Rationale The accumulation of bile salts causes jaundice and pruritus in the patient with liver cirrhosis. The patient's pruritus is not caused by ascites, poor diet, or poor hygiene.

Jaundice, which causes the accumulation of bile salts under the skin

A nurse is administering lactulose to a patient with hepatic encephalopathy caused by liver cirrhosis. The patient's wife requests to know why her husband is being given this medication because he is not constipated. The nurse replies that lactulose decreases ammonia levels through which mechanism? Lactulose increases the bacterial metabolism of ammonia. Lactulose decreases bacterial production of ammonia. Lactulose reduces the number of ammonia-producing bacteria in the colon. Lactulose increases the number of ammonia-metabolizing bacteria in the colon. Rationale Lactulose acidifies the bowel, which decreases the production of ammonia by bacteria in the bowel. Bacteria in the bowel do not metabolize ammonia. Neomycin, not lactulose, reduces the number of ammonia-producing bacteria in the colon.

Lactulose increases bacterial metabolism of ammonia.

A nurse is caring for a patient with moderate symptoms caused by three gallstones. Which procedure would the nurse prepare the patient for? Lithotripsy Open cholecystectomy Endoscopic sphincterotomy Laparoscopic cholecystectomy Rationale Mild to moderate symptoms caused by just a few gallstones are treated by lithotripsy to break up the stones. Open cholecystectomy, endoscopic sphincterotomy, and laparoscopic cholecystectomy are reserved for the treatment of multiple gallstones and more serious diseases.

Lithotripsy

A patient arrives at the clinic with a yellow discoloration of the skin and the sclera. The nurse anticipates the health care provider will prescribe tests to determine the function of which organ? Liver Spleen Kidneys Small intestine Rationale Bilirubin, which is normally broken down in the liver, causes jaundice, a yellow discoloration of the skin when the liver is not functioning properly. Jaundice is not caused by spleen, kidney, or small intestine dysfunction.

Liver

Which condition does the nurse suspect in a patient with dull abdominal pain, clay-colored stools, dark urine, fever, hepatomegaly, jaundice, and anemia? Cholecystitis Liver abscess Liver cirrhosis Hepatic encephalopathy Rationale Liver abscess is the collection of pus in the liver caused by bacterial infections. These infections retard the liver's function, and the patient experiences dull abdominal pain. Abnormal functioning of the liver results in increased bilirubin content, indicated by clay-colored stools and dark urine. Hepatomegaly, jaundice, and anemia in the patient confirm the presence of liver abscess. Cholecystitis is characterized by such symptoms as pain in the right upper quadrant epigastric region, anorexia, nausea, vomiting, and flatulency. Liver cirrhosis is characterized by dyspepsia, changes in bowel habits, gradual weight loss, ascites, enlarged spleen, malaise, nausea, jaundice, and ecchymoses. Hepatic encephalopathy is characterized by symptoms that progress from inappropriate behavior, disorientation, asterixis, and twitching of the extremities.

Liver abscess

A patient with cholecystostomy has an accidental obstruction of bile drainage. Which nursing intervention may reduce the risk for impaired skin integrity? Maintaining patency of the T-tube Applying enough tension on the T-tube Emptying the bile bag after it is completely filled Changing and applying moist dressing, as ordered Rationale Maintaining the patency of the T-tube is a primary nursing intervention. This promotes the draining of the obstructed bile through the opening of the T-tube. Drainage of the obstructed bile retards if pressure is applied on the T-tube. If the bag is changed after it is fully filled, it may soil the linen, causing discomfort to the patient. The bile bag should be emptied after it is half-filled. Moist dressing may cause infections; the dressing applied should be dry.

Maintaining patency of the T-tube

A patient with cholelithiasis is complaining of severe abdominal pain. Which pain Grab screen area, OCR, and copy results to clipboard medication ordered by the provider would the nurse question? Morphine Ketorolac (Toradol) Dicyclomine (Bentyl) Meperidine (Demerol) Rationale Morphine can cause an increased tone in the sphincter of Oddi and slow the flow of bile into the duodenum, which can lead to an increase in symptoms. Ketorolac and meperidine are good options for pain control. Dicyclomine decreases spasms of the sphincter of Oddi and pain.

Morphine

A patient with late-stage liver cirrhosis arrives in the clinic with several complaints. Which symptom concerns the nurse the most because it puts the patient at risk for a potentially life-threatening complication? Pruritus Diarrhea Nonproductive cough Increased abdominal girth Rationale The patient with cirrhosis is at risk for esophageal varices, which can rupture when the patient coughs and cause hemorrhage. Diarrhea, pruritus, and increased abdominal girth are all symptoms expected to be present in a patient with cirrhosis.

Nonproductive cough

A patient undergoing a paracentesis to remove ascitic fluid complains of dizziness and lightheadedness. Which action should the nurse take first? Increase the flow of fluid. Decrease the flow of fluid. Obtain the patient's vital signs. Remove the catheter immediately. Rationale The patient is likely experiencing syncope because the fluid was removed too quickly. The nurse should first determine the patient's blood pressure and pulse. It may be necessary to decrease the flow of fluid, but the nurse should first determine the cause of the patient's symptoms. It would not be appropriate to increase the flow of fluid or remove the catheter immediately.

Obtain the patient's vital signs.

A patient undergoing a paracentesis to remove ascitic fluid complains of dizziness and lightheadedness. Which action should the nurse take first? Increase the flow of fluid. Decrease the flow of fluid. Obtain the patient's vital signs. Remove the catheter immediately.

Obtain the patient's vital signs. Rationale The patient is likely experiencing syncope because the fluid was removed too quickly. The nurse should first determine the patient's blood pressure and pulse. It may be necessary to decrease the flow of fluid, but the nurse should first determine the cause of the patient's symptoms. It would not be appropriate to increase the flow of fluid or remove the catheter immediately.

The nurse discovers a patient is sitting up in bed reading the newspaper after having had a fine-needle aspiration biopsy (FNAB) of the liver 15 minutes before. Which position would the nurse place the patient in? On the patient's left side On the patient's right side Semi-Fowler's position Trendelenburg's position Rationale After FNAB of the liver, it is important for the patient to lie on the right side for a minimum of 2 hours to splint the puncture site. In this position, the liver capsule is compressed against the chest wall, thereby decreasing the risk of hemorrhage or bile leak. Trendelenburg's position is not the recommended position after FNAB of the liver. Placement on the patient's left side is also not the recommended position because the liver is located on the patient's right. Semi-Fowler's position is not the recommended position after FNAB of the liver.

On the patient's left side

The nurse discovers a patient is sitting up in bed reading the newspaper after having had a fine-needle aspiration biopsy (FNAB) of the liver 15 minutes before. Which position would the nurse place the patient in? On the patient's left side On the patient's right side Semi-Fowler's position Trendelenburg's position Rationale After FNAB of the liver, it is important for the patient to lie on the right side for a minimum of 2 hours to splint the puncture site. In this position, the liver capsule is compressed against the chest wall, thereby decreasing the risk of hemorrhage or bile leak. Trendelenburg's position is not the recommended position after the FNAB of the liver. Placement on the patient's left side is also not the recommended position because the liver is located on the patient's right. Semi-Fowler's position is not the recommended position after the FNAB of the liver.

On the patient's right side

A patient with cirrhosis of the liver is admitted to the hospital for moderate respiratory distress as a result of ascites. The nurse knows to prepare the patient for which procedure? Paracentesis Thoracentesis Esophagoscopy Barium esophagography Rationale Paracentesis is a procedure in which fluid is withdrawn from the abdominal cavity. This buildup of fluid is likely the cause of the patient's respiratory distress. A thoracentesis drains fluid from the chest cavity and is not applicable to this patient. Although the patient may need an esophagoscopy with barium esophagography to determine if the patient has esophageal varices, these are not the best options at this time.

Paracentesis

The nurse is a caring for a patient with a chronic hepatitis B infection. Which drug does the nurse expect the health care provider to prescribe to treat the infection and decrease the viral load? Ribavirin (Rebetol) Pegylated interferon alfa (Pegasys) Interferon alfa-2b (Intron A) Azathioprine (Imuran) Rationale Drugs that are considered first-line treatment for chronic hepatitis B virus infection include pegylated interferon alfa (Pegasys), entecavir (ETV), and tenofovir disoproxil fumarate (TDF). Ribavirin (Rebetol) also decreases the viral load but treats hepatitis C infections. Interferon alfa-2b (Intron A) acts as a static drug and decreases the disease progression in hepatitis C infections. Azathioprine (Imuran) is an immunosuppressant used in liver transplant recipients.

Pegylated interferon alfa (Pegasys)

A patient with cirrhosis and esophageal varices is vomiting, and the nurse notes hematemesis. Which action should the nurse take first? Call the health care provider. Place the patient in the side-lying position. Stay with the patient until the vomiting subsides. Encourage the patient to continue vomiting to clear the stomach of blood. Rationale A bleeding varix is a medical emergency. An airway must be maintained, so the patient should first be placed in the side-lying position to prevent aspiration. The health care provider should then be notified. The nurse should stay with the patient until the vomiting subsides and ensure that the patient's airway is maintained. The patient should not be encouraged to continue vomiting.

Place the patient in the side-lying position.

Which type of liver cirrhosis is caused by viral hepatitis, exposure to hepatotoxins Grab screen area, OCR and copy results (e.g., Industrial chemicals), or infection? Laennec's cirrhosis Alcoholic cirrhosis Postnecrotic cirrhosis Primary biliary cirrhosis

Postnecrotic cirrhosis

The nurse is caring for a patient with nonbleeding esophageal varices. Which drug does the nurse expect the health care provider to prescribe to ensure safety of the patient? Propranolol (Inderal) Cimetidine (Tagamet) Vasopressin (Pitressin) Nitroglycerin (Nitro-Bid) Rationale Esophageal varices are characterized by enlarged and edematous veins at the lower end of the esophagus. The patient is susceptible to hemorrhage; however, a few patients may not have bleeding. As this patient has no bleeding, prophylactic treatment with nonselective beta-blockers, such as propranolol (Inderal), reduces the risk of bleeding and bleeding-related deaths. Cimetidine (Tagamet) is an antacid and is used to prevent gastric stress ulcers. Vasopressin (Pitressin) is administered intravenously to stop hemorrhage and is not administered in the patient who does not have bleeding. Nitroglycerin (Nitro-Bid) is used for therapeutic management of ruptured esophageal varices.

Propranolol (Inderal)

The nurse would instruct a patient who is recovering from an acute episode of hepatic encephalopathy to avoid a diet rich in which component? Minerals Vitamins Proteins Carbohydrates Rationale Ammonia is produced after the digestion of proteins. In patients with hepatic encephalopathy, ammonia cannot be eliminated from the body; protein intake is restricted in these patients. A protein-rich diet causes an excessive accumulation of ammonia in the body and is contraindicated in patients with hepatic encephalopathy. A diet rich in minerals is not contraindicated, and minerals are essential for the metabolic activities of the body. Vitamins are also required in moderate levels and are not contraindicated in patients with hepatic encephalopathy. Carbohydrates are not contraindicated in patients with hepatic encephalopathy. They are an essential source of glucose and can be taken in moderate amounts.

Proteins

The nurse is caring for patient with severe liver cirrhosis and imbalanced nutrition. Which nursing intervention would prevent malnutrition in this patient? Encourage high protein intake. Provide oral care before meals. Provide large meals to the patient. Avoid administering antiemetic drugs to the patient. Rationale The patient with liver cirrhosis shows less interest in food intake, which may lead to malnutrition. It is required to provide oral care to patients with liver cirrhosis before meals to remove the foul taste in their mouths and improve the taste of food. When digested, proteins produce ammonia, which is not eliminated in patients with severe liver cirrhosis. It is, therefore, not advised to provide protein-rich food. It is advised to provide small, frequent meals at times the patient can best tolerate them to prevent a feeling of fullness and maintain nutritional status. Antiemetics are to be administered, per the prescription, to relieve nausea and vomiting while eating.

Provide oral care before meals.

Grab screen area, OCR and copy results to clipboard with an unlicensed assistive personnel (UAP) to care for a patient with cirrhosis of the liver. The nurse overhears the UAP say, "This patient did this to himself by being an alcoholic. I don't understand why we're trying to save him." Which action should the nurse take? Report the UAP to the nurse manager. Say nothing. The UAP is entitled to an opinion. Remind the UAP that cirrhosis is also caused by factors other than alcohol. Tell the UAP, "You are right; we should not help him." Rationale Cirrhosis of the liver can be caused by alcohol, hepatitis viruses, gallstones, and other causes. The nurse should first remind the UAP of these other causes. It is necessary to tell the UAP that each patient deserves the best care regardless of how the patient came to be in his or her condition. Should the UAP compromise the care of the patient, the nurse should report the UAP to the nurse manager. It is not appropriate to remain silent in this situation.

Remind the UAP that cirrhosis is also caused by factors other than alcohol.

The nurse is caring for a patient with hepatic encephalopathy who is administered lactulose (Chronulac). Which biochemical level does the nurse monitor to ensure the patient's safety? Serum sodium Serum ammonia Serum creatinine Serum potassium Rationale The drug lactulose (Chronulac) retards ammonia absorption by acidifying the colonic contents. The nurse should, therefore, monitor serum ammonia levels after the administration of lactulose (Chronulac). The nurse should monitor serum sodium levels after administering vasopressin (Pitressin) because it is an antidiuretic. Serum creatinine levels should be monitored in the patient after the administration of spironolactone (Aldactone). Spironolactone (Aldactone) retains potassium in patients with liver cirrhosis; the nurse should, therefore, monitor serum potassium levels.

Serum ammonia

Which dinner option would be best for a patient who was admitted with acute hepatic encephalopathy? Cheeseburger and French fries Grilled chicken with broccoli and cheese Spaghetti with marinara sauce and salad Ham and cheese sandwich with tomato soup Rationale Patients recovering from acute hepatic encephalopathy may require a protein-restricted diet. Spaghetti with marinara sauce and salad is low in protein. Cheeseburgers, grilled chicken, and ham are all protein-rich foods.

Spaghetti with marinara sauce and salad

A patient admitted to the hospital with cirrhosis of the liver suddenly starts vomiting blood. Which nursing action is priority in this situation? Give propranolol orally. Check for signs of cirrhosis. Prepare the patient for endoscopic variceal ligation. Stabilize the patient, and manage the airway. Rationale Individuals with cirrhosis of the liver are at risk of bleeding from esophageal and gastric varices. Hematemesis in the patient with cirrhosis of the liver is likely to be because of variceal bleeding. In this case, the nurse should first stabilize the patient and manage the airway. Once the patient is stable, other steps in treatment can be initiated, such as assessing further and administering medications, checking signs of cirrhosis, or preparing for further treatment.

Stabilize the patient, and manage the airway.

A nurse is preparing a patient for a fine-needle aspiration biopsy of the liver. The nurse correctly positions the patient in which manner? Prone Supine Lithotomy Trendelenburg's Rationale The patient should lie supine with the right arm elevated over the head. Prone, lithotomy, and Trendelenburg's positions would not be appropriate for this test.

Supine

Grab screen area, a patient who underwent cholecystectomy. Which diagnostic test does the nurse expect the health care provider to prescribe to detect bile ductal stones? Urine amylase test Serum amylase test Oral cholecystography T-tube cholangiography Rationale T-tube cholangiography is performed to detect retained bile ductal stones postoperatively in the patient who had a cholecystectomy. The urine amylase test is particularly useful in detecting pancreatitis late in the course of the disease. The serum amylase test can aid in quickly diagnosing pancreatitis in its early stages. Oral cholecystography provides a radiographic visualization of the gallbladder.

T-tube cholangiography

A patient expresses concern about getting pregnant while the partner is on ribavirin (Rebetol) therapy for chronic hepatitis C. Which information would the nurse give to the patient? The person can plan pregnancy now. The person should avoid getting pregnant now. The person should not get pregnant with this partner. The person should avoid any sexual intercourse after conception. Rationale Any woman who is on ribavirin (Rebetol) or whose male partner is on ribavirin should avoid pregnancy during treatment. Pregnancy can be planned after the treatment has been completed. The person can get pregnant with the current partner, but not while on treatment. Avoiding intercourse after conception is not necessary.

The person should avoid getting pregnant now.

Following a laparoscopic cholecystectomy, a patient without pre- or postoperative complications is being discharged from the hospital. Which instructions would the nurse include in the discharge teaching? Select all that apply. Take a shower. Increase fat in the diet during recovery. Wait 1 week after surgery to return to work. Take complete bed rest for at least 2 weeks. Notify the surgeon of any redness and swelling at the incision site. Rationale The patient who undergoes a laparoscopic cholecystectomy without complications may be discharged shortly after surgery. Therefore, it iS important to teach the patient about care following discharge. The patient should be informed to take a shower. Normal activities can be resumed the next day, and the patient may return to work within 1 week of surgery. The patient should immediately notify the surgeon if there is redness, swelling, bile-colored drainage, or pus from any incision; severe abdominal pain; nausea; vomiting; and/or fever and chills. If the patient has no complications, the patient does not need to take bed rest for 2 weeks. A normal diet can also be resumed, but a low-fat diet is recommended for several weeks after surgery.

Take a shower. Wait 1 week after surgery to return to work. Notify the surgeon of any redness and swelling at the incision site.

Why would the health care provider prescribe cimetidine (Tagamet) to a patient with acute pancreatitis? To reduce stomach pH To prevent stress ulcers To treat secondary infections To increase pancreatic activity Rationale Pancreatic juice is alkaline in nature, as it has more bicarbonate ions. It maintains the gastric pH; however, in patients with pancreatitis, pancreatic activity is reduced, which may result in stress ulcers. Therefore, antacids, such as cimetidine (Tagamet), should be prescribed to prevent stress ulcers. In pancreatitis, the pH of the stomach is reduced and cimetidine (Tagamet) is an antacid that elevates gastric pH. Secondary infections are not treated with cimetidine (Tagamet) because it is not an antibiotic. Cimetidine (Tagamet) is not associated with altering pancreatic activity.

To prevent stress ulcers

Which imaging technique visualizes deep structures of the body by recording reflections or echoes of ultrasonic waves directed into the tissues? Angiography Hepatobiliary iminodiacetic acid (HIDA) scanning Ultrasonography Percutaneous biopsy

Ultrasonography

Which vitamin supplements does the health care provider prescribe for a patient with ascites? Select all that apply. Vitamin K Vitamin C Vitamin D Vitamin B 9 Vitamin B 12 Rationale Patients with severe fluid retention are prescribed spironolactone (Aldactone) to promote dieresis. Vitamin supplements, such as vitamin K, vitamin C, and vitamin B (folic acid), also induce diuresis in the patient. These vitamin supplements synergize the actions of spironolactone (Aldactone) by promoting diuresis in severe conditions. Vitamin D is associated with the absorption of calcium in the intestines and is not associated with diuresis. Vitamin B 12 is associated with the formation of blood cells and does not produce any diuretic effect.

Vitamin K Vitamin C Vitamin B 9

A nurse is contributing to the admission assessment of a patient in the early stages of cirrhosis of the liver. The nurse anticipates the patient to report which symptoms? Select all that apply. Pruritus Vomiting Diarrhea Flatulence Severe fatigue Loss of appetite Rationale In the early stages of cirrhosis of the liver, the patient experiences nausea and vomiting, abnormal bowel function, flatulence, weakness, and loss of appetite. Severe fatigue and pruritus are some of the symptoms experienced in the late stages.

Vomiting Diarrhea Flatulence Loss of appetite

A patient is scheduled to undergo T-tube cholangiography. Before administration of contrast dye, which allergy would the nurse check the patient for? lodine Peanuts Silk tape Strawberries Rationale Before administration of contrast dye, it is essential that the nurse determine if the patient has an allergy to iodine. Patients with iodine allergies may react to the contrast dye, and this reaction can be life-threatening. There has been no documentation that a strawberry allergy would place a patient at risk for an allergy to contrast dye; however, people who are allergic to strawberries are often allergic to other foods and substances. All allergies should be clearly documented on the appropriate part of the medical record. There has been no documentation that a peanut allergy would place the patient at risk for an allergy to contrast dye; however, people who are allergic to peanuts are often allergic to other foods and substances. There has been no documentation that an allergy to silk tape would place the patient at risk for an allergy to contrast dye. Any such allergy, which would manifest as redness near areas with silk tape, would be uncomfortable for the patient, but not life-threatening.

lodine