Ch 35 NC of Pts with Liver, Pancreatic, and Gallbladder Diseases

The nurse is collecting data on a patient with hepatitis. Which of the following signs or symptoms are a priority for the nurse to report? (Select all that apply) 1. Bruising 2. Fever 3. Nausea 4. Malaise 5. Pruritus

1. Bruising 2. Fever

The nurse is collecting data for a patient with acute pancreatitis. Which of these descriptions of pain would the nurse associate with acute pancreatitis? 1. Dull, boring, beginning in the mid-epigastrium and radiating to the back 2. Knifelike, centered in the left lower quadrant 3. Burning, focused over the left flank and radiating to the shoulder 4. Sharp, severe pain that begins in the right upper quadrant

1. Dull, boring, beginning in the mid-epigastrium and radiating to the back

A patient recovering from hepatitis is concerned about liver damage from the infection. Which instructions does the nurse provide the patient to prevent long-term liver damage? (Select all that apply.) 1.Get adequate rest. 2.Ingest nutritious foods. 3.Abstain from all alcohol. 4.Restrict physical activity. 5.Limit the intake of dairy products.

1. Get adequate rest. 2.Ingest nutritious foods. 3.Abstain from all alcohol. Rationales: Recovery varies and depends on the type of hepatitis. Full recovery is measured by the return to normal of all liver function tests and may take as long as 1 year. The effects of hepatitis can be considered reversible if the patient complies with a medical regimen of adequate rest, proper nutrition, and abstinence from alcohol or other liver-toxic agents for at least 1 year after liver function laboratory values return to normal.

The nurse is collecting data for a patient with suspected acute hepatitis A infection. Which clinical manifestations would the nurse expect the patient to report? (Select all that apply) 1. Headache 2. Flu-like symptoms 3. Light-colored stools 4. Nausea 5. Abdominal pain 6. Brown-colored urine

1. Headache 2. Flu-like symptoms 4. Nausea

A patient with cirrhosis has asterixis and fetor hepaticus and is confused. The nurse recognizes these as symptoms of which complication? 1. Hepatic encephalopathy 2. Hepatorenal syndrome 3. Portal hypertension 4. Ascites

1. Hepatic encephalopathy

The nurse is providing care for a patient admitted with acute liver failure related to an acetaminophen overdose. Which goal is associated with care for the patient? 1. Maintain functional ability of the liver. 2. Keep the patient on complete bed rest. 3. Monitor for the need to initiate intubation. 4. Provide a diet high in vitamins and protein.

1. Maintain functional ability of the liver. Rationale: The overall goal when caring for a patient in acute liver failure is to attempt to put the liver completely at rest to maintain functional ability.

The nurse provides teaching on medications that contain acetaminophen to use cautiously for a patient with cirrhosis. Which of these medications would the patient correctly state should be used cautiously? (Select all that apply) 1. Norco 2. Nyquil 3. Penicillin 4. Percocet 5. Tetracycline 6. Vicodin

1. Norco 2. Nyquil 4. Percocet 6. Vicodin

The nurse reinforces teaching for a patient after a cholecystectomy who is on a low-fat diet. The nurse will know that the patient understands the diet if which menu items are selected? 1. Roasted chicken, rice, gelatin desert 2. Cream of chicken soup, milk, gelatin desert 3. Meat loaf, mashed potatoes with small amount of gravy, green beans 4. Turkey and cheese sandwich on whole-grain bread, apple, milk

1. Roasted chicken, rice, gelatin desert

Which of the following is a treatment for bleeding esophageal varices? (Select all that apply) 1. Variceal ligation (banding) 2. Octreotide (Sandostatin) IV 3. Soft diet 4. Clear liquid diet 5. Transjugular intrahepatic portosystemic shunt

1. Variceal ligation (banding) 2. Octreotide (Sandostatin) IV 5. Transjugular intrahepatic portosystemic shunt

The nurse is preparing to reinforce discharge teaching for a patient who underwent a cholecystectomy. Which information does the nurse plan to cover? (Select all that apply.) 1.Increase high-quality protein to promote healing. 2.Avoid dietary fats to prevent postoperative nausea or pain. 3.Call the HCP if fever, redness, or drainage indicates infection. 4.Increase fluid intake to flush excess bilirubin from the system. 5.Reintroduce fats slowly back into the diet to prevent rebound effects.

1.Increase high-quality protein to promote healing. 2.Avoid dietary fats to prevent postoperative nausea or pain. 3.Call the HCP if fever, redness, or drainage indicates infection. 5.Reintroduce fats slowly back into the diet to prevent rebound effects. Rationales: The nurse needs to reinforce the importance of dietary protein to promote healing. Initially, the patient should avoid dietary fats to prevent postoperative intolerance. The duodenum needs to become accustomed to the constant infusion of bile from the liver. All surgical patients need to be aware of the signs of infection and when to call the HCP. Fats need to be reintroduced in small amounts and over a period of time to allow the duodenum to become accustomed to the constant infusion of bile from the liver.

A patient presents at the HCP's office with epigastric pain. The patient's temperature and pulse and respiration rates are all elevated. Which additional symptom will the nurse associate as a possible sign of cholelithiasis? 1.Jaundice 2.Vomiting 3.Heartburn 4.Flatulence

1.Jaundice R Jaundice is most commonly indicative of cholelithiasis because the common bile duct is either inflamed or blocked by a gallstone.

The nurse is providing care for a patient admitted with serious acute pancreatitis. The patient is in guarded condition and exhibits multiple manifestations of pancreatitis complications. The nurse is aware that which body system is unlikely to lead to patient death? 1.Neurologic 2.Cardiovascular 3.Respiratory 4.Renal/kidney

1.Neurologic Rationale: Any involvement of the neurologic system is unlikely to occur with acute pancreatitis.

A patient just receives a diagnosis of pancreatic cancer with metastasis to the liver, gallbladder, and stomach. The nurse is informed that the patient has agreed to palliative care. Which intervention seems unexpected to the nurse? 1.Performance of a Whipple procedure 2.Surgery to bypass a blocked bile duct 3.Chemotherapy and radiation therapy 4.Surgical placement of a bile duct stent

1.Performance of a Whipple procedure Rationale: An unexpected intervention would be for performance of a Whipple procedure that is aimed at curing pancreatic cancer.

The nurse is caring for a patient with chronic pancreatitis. While reviewing lab data, the nurse would expect an elevation in which serum lab value? 1. Albumin 2. Amylase 3. Bilirubin 4. Calcium

2. Amylase

Which of the following instructions should the nurse include in the teaching plan for the patient with portal hypertension? (Select all that apply) 1. Cough and deep breathe every 2 hours 2. Avoid straining to have a BM 3. Avoid heavy lifting 4. Increase fluid intake 5. Take vitamin K supplement 6. Consult HCP before use of aspirin

2. Avoid straining to have a BM 3. Avoid heavy lifting 6. Consult HCP before use of aspirin

The nurse is collecting data from a patient with liver failure to detect hepatic encephalopathy. Which instruction does the nurse give to the patient to collect the data? 1."Stand with your eyes closed." 2."Hold out your arms and hands." 3."Kneel on your hands and knees." 4."Perform a Valsalva's maneuver."

2."Hold out your arms and hands." Rationale: Neuromuscular function is monitored by asking the patient to hold his or her arms out straight in front and steady. If asterixis, or liver flap, is present, the patient's hands will unwillingly dip and return to the horizontal position in a flapping motion.

The nurse is planning care for a patient with cirrhosis. For which condition would the nurse place the patient on bleeding precautions? 1. Encephalopathy 2. Low vitamin K 3. Elevated liver enzymes 4. Hepatorenal syndrome

2. Low vitamin K

The nurse is collecting data for a patient admitted with possible cholecystitis. Which of the following does the nurse recognize as risk factors for gallbladder disease? (Select all that apply) 1.Male gender 2. Obesity 3. Multiple pregnancies 4. Age 40 or older 5. Fasting 6. DM

2. Obesity 3. Multiple pregnancies 4. Age 40 or older 5. Fasting 6. DM

The nurse is caring for a patient who has an open cholecystectomy 24 hours ago. Which actions should the nurse take to assist the patient to maintain an effective breathing pattern? (Select all that apply) 1. Place in a supine position 2. Provide analgesics for pain relief 3. Encourage coughing and deep breathing 4. Monitor bowel sounds 5. Assist with splinting during coughing 6. Maintain bedrest for 48 hours after surgery

2. Provide analgesics for pain relief 3. Encourage coughing and deep breathing 5. Assist with splinting during coughing

Which of the following precautions will protect the nurse who is caring for the patient with hepatitis B? 1. Reverse isolation 2. Standard precautions 3. Respiratory precautions 4. Enteric precautions

2. Standard precautions

The nurse is assisting with the care of a patient following a liver transplant for cirrhosis. Which finding will the nurse report immediately to the RN or HCP? 1.Surgical pain greater than 4 on a 0-to-10 scale 2.Decrease in the amount of bile in the T-tube 3.Difficulty with taking deep breaths or coughing 4.A regular apical pulse rate of 98 beats/min

2.Decrease in the amount of bile in the T-tube Rationale: A decrease in the amount of bile in the T-tube drainage system is an indication of impending rejection of the newly transplanted liver. The nurse needs to inform the RN or HCP immediately.

The nurse is obtaining information from a patient who is obese and has diabetes mellitus (DM). Upon physical examination, the nurse notes generalized ecchymosis, an enlarged and tender liver with palpation, and evidence of ascites with percussion. Which possible disease condition does the nurse identify from the findings? 1.Diabetic complications 2.Liver dysfunction 3.Acute kidney disorder 4.Deficient blood clotting

2.Liver dysfunction Rationale: The manifestations and medical history are common for the development of liver dysfunction. The patient is likely to be diagnosed with cirrhosis of the liver.

The nurse is reinforcing patient teaching regarding the causes of gallbladder disorders. Which condition does the nurse present as being a common cause? 1.Metastasis of cancer from the liver 2.Obesity and high dietary intake of fats 3.Gallstones and inflammations 4.History of excessive alcohol intake

3.Gallstones and inflammations Rationale: The presence of gallstones and inflammations are the most common cause of gallbladder disorders.

A patient with ascites is placed on a low-sodium diet. The nurse knows that diet teaching has been successful if the patient selects which of the following meals? 1. Cottage cheese and peaches with tomato juice 2. Frankfurter on a bun with pickle relish and skim milk 3. Baked chicken, brown rice, and apple juice 4. Turkey and lettuce sandwich on whole-wheat bread with tomato soup

3. Baked chicken, brown rice, and apple juice

The nurse is collecting data for a patient who develops jaundice and dark-colored urine. The nurse recognizes that which of the following is most likely the cause of these clinical manifestations? 1. Encephalopathy 2. Pancreatitis 3. Bile duct obstruction 4. Cholecystitis

3. Bile duct obstruction

Patients with a history of pancreatitis commonly have a history of which of the following? 1. High-protein diet 2. Very-low fat diet 3. Excessive alcohol consumption 4. Excessive intake of vitamin K

3. Excessive alcohol consumption

The nurse provides teaching on prevention of hepatitis. The nurse recognizes that the patient requires further instructions if the patient states which of the following? (Select all that apply) 1. I should receive the vaccine for hepatitis A virus 2. I should receive the vaccine for hepatitis B virus 3. I should receive the vaccine for hepatitis C virus 4. I should receive the vaccine for hepatitis D virus 5. Hand washing is important after use of the bathroom 6. I can share my razor

3. I should receive the vaccine for hepatitis C virus 4. I should receive the vaccine for hepatitis D virus 6. I can share my razor

The nurse is caring for a patient with cirrhosis. The nurse would cautiously use sedatives for the patient due to which of the following? 1. The liver's ability to synthesize protein is altered 2. Sedatives may increase the risk for jaundice 3. Sedatives are potentially toxic to the cirrhosis patient 4. Sedatives promote the conversion of ammonia to ammonium ion

3. Sedatives are potentially toxic to the cirrhosis patient

The nurse is gathering information about a new patient in an adult clinic. The patient states, "I have severe arthritis, but I control the pain with two 650-mg acetaminophen tablets four times a day." Which condition does the nurse associate with the patient's medication regimen? 1.Urinary retention 2.Gastric bleeding 3.Liver failure 4.Kidney disease

3.Liver failure Rationale: Liver failure is frequently connected to the overuse of acetaminophen.

A patient reports that a family member is diagnosed with hepatitis and asks the nurse the best way to prevent becoming infected. Which is the best information for the nurse to provide? 1.Expose fabric or unwashable items to ultraviolet light. 2.Thoroughly scrub hard surfaces with a strong bleach solution. 3.Perform frequent hand washing and do not share personal items. 4.Immediately start and complete a prophylactic antibiotic regimen.

3.Perform frequent hand washing and do not share personal items. Rationale: The best information the nurse can provide is the correct way to perform hand hygiene and to not share personal items. If personal items are contaminated, they are to be discarded if possible; boiling in water for 30 minutes is also effective.

The nurse is providing care for a patient diagnosed with chronic pancreatitis. The patient's vital signs are blood pressure 130/78 mm Hg, respirations 28 breaths/min and labored with O2 saturation rate of 90%, pulse 102 beats/min, and pain level of 7 on a 0-to-10 scale. Which immediate nursing action is appropriate? 1.Observe for use of accessory or intercostal muscles. 2.Validate when the last pain medication was administered. 3.Place in an upright or slightly leaning forward position. 4.Seek approval to begin or increase delivery of oxygen therapy.

3.Place in an upright or slightly leaning forward position. Rationale: The nurse should immediately ascertain that the patient is experiencing breathing and oxygenation issues. The patient should be immediately placed upright or slightly leaning forward to promote lung expansion and oxygenation.

The nurse is providing care for a client following an open cholecystectomy involving the removal of large gallstones and placement of a T-tube. Which third day postsurgical manifestation will cause the nurse to report the finding? 1.Deep breathing and coughing improves with incisional splinting. 2.Pain level remains between 3 and 5 depending on patient activity. 3.T-tube drainage is 600 mL over the past 24-hour period. 4.Patient complains about receiving a soft, low-fat diet.

3.T-tube drainage is 600 mL over the past 24-hour period. Rationale: By the third postoperative day, the patient's T-tube drainage should not be more than 200 mL; an amount of 600 mL is a matter of concern and should be reported.

A patient with liver failure and esophageal varices is prescribed to receive vasopressin. For which purpose does the nurse recognize the need for this medication? 1.To promote portal circulation 2.To reduce ammonia buildup and encephalopathy 3.To constrict vessel dilation to the esophageal varices 4.To maintain hypotension related to bleeding varices

3.To constrict vessel dilation to the esophageal varices Rationale: Vasopressin is a vasoconstrictor and will reduce the possibility or help manage bleeding related to esophageal varices.

Acute liver failure is most often caused by which of the following? 1. Antibiotic use 2. Daily vitamins 3. Alcohol use 4. Acetaminophen (Tylenol) overdose

4. Acetaminophen (Tylenol) overdose

The nurse is planning care for a newly admitted patient with acute pancreatitis. Which patient outcome should receive the highest priority in the plan of care? 1. Patient increases activity tolerance 2. Patient maintains normal bowel function 3. Patient verbalizes understanding of medications at discharge 4. Patient expresses satisfaction with pain control

4. Patient expresses satisfaction with pain control

A patient is being treated for acute cholecystitis. The patient is instructed on dietary measures to reduce the possibility of recurrent episodes. Which patient comment indicates a need to reinforce teaching? 1."I will need to limit the amount of fat in my diet." 2."I can increase my intake of nuts and avocados." 3.While I am having an attack, I may need to be NPO." 4."I need to get my extra weight off as quick as possible."

4."I need to get my extra weight off as quick as possible." Rationale: Fasting or strict weight-loss diets can trigger cholecystitis; the patient needs to aim for a slow, steady weight loss. This comment warrants additional teaching.

The nurse is collecting data from a patient with acute pancreatitis. Which symptoms should the nurse anticipate? 1.Low abdominal pain, bradycardia, and confusion 2.Shortness of breath, hypotension, and restlessness 3.Fever, tachycardia, right upper quadrant pain, and jaundice 4.Abdominal distention, respiratory distress, and mid-epigastric pain

4.Abdominal distention, respiratory distress, and mid-epigastric pain Rationale: Patients with acute pancreatitis are very ill, with dull abdominal pain, guarding, a rigid abdomen, hypotension or shock, and respiratory distress from accumulation of fluid in the retroperitoneal space. The abdominal pain is generally located in the midline just below the sternum, with radiation to the spine, back, and flank.

The nurse is providing care for an older adult patient with a diagnosis of small noncalcified gallstones. The HCP prefers to avoid surgery on the patient due to age and a medical history of cardiac disorders. Which medical treatment does the nurse most likely expect the HCP to prescribe? 1.Dietary alterations and limitations 2.Management of cholecystitis flare-ups 3.Routine anti-inflammatory medications 4.Long-term treatment with a dissolution drug

4.Long-term treatment with a dissolution drug Rationale: Due the fact that the patient is considered a high surgical risk, the HCP is likely to use long-term treatment with a dissolution drug to get rid of the gallstones. However, the treatment may take up to 2 years, and the gallstones are apt to return.

The nurse is reinforcing teaching provided to a patient with esophageal varices. Which suggestion is the least important? 1.Avoid lifting heavy objects. 2.Bleeding is a reason to call 911. 3.Keep appointments with the health care provider (HCP). 4.Maintain low physical activity.

4.Maintain low physical activity. Rationale: There is no indication that the patient needs to maintain a low physical activity; however, any activity that increases the blood pressure or intraabdominal pressure should be avoided.

A patient with biliary colic is prescribed an anticholinergic medication to help treat the condition. For which medical diagnosis should the nurse question the administration of this medication? 1.Asthma 2.Psoriasis 3.DM 4.Prostatic hypertrophy

4.Prostatic hypertrophy Rationale: Anticholinergic medications are contraindicated in patients with prostatic hypertrophy; there is a high risk for urinary retention.