Chapter 43: Liver, Pancreas, and Biliary Tract Problems

During a follow-up visit, the nurse finds that the condition of a patient with cholelithiasis has improved. Which food included in the patient's diet most likely facilitated the improvement? A. Butter B. Yogurt C. Cheese D. Skim milk

D. Skim milk

A patient with hepatitis A is in the acute phase. The nurse plans care while anticipating that the patient may be experiencing which symptoms? Select all that apply. A. Fatigue B. Pruritus C. Anorexia D. Dizziness E. Visual disturbances

A. Fatigue B. Pruritus C. Anorexia

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching? A. "If I notice a fast heart rate or irregular beats, it is normal for cirrhosis." B. "I need to take good care of my belly and ankle skin where it is swollen." C. "A scrotal support may be more comfortable when I have scrotal edema." D. "I can use pillows to support my head to help me breathe when I am in bed."

A. "If I notice a fast heart rate or irregular beats, it is normal for cirrhosis."

The nurse is performing education to a patient undergoing a Whipple procedure. Which statement demonstrates that the patient needs further education regarding the Whipple procedure? A. "It involves complete removal of the stomach." B. "It involves complete removal of the duodenum." C. "It involves removal of a portion of the bile duct." D. "It involves removal of a portion of the pancreas."

A. "It involves complete removal of the stomach."

While caring for a patient with pancreatitis, a nurse finds that the patient's blood pressure is 80/70 mm Hg and the nurse suspects hypovolemia. Which treatment option does the nurse expect to be effective? A. Administration of albumin B. Administration of octreotide C. Administration of cyclosporine D. Administration of acetazolamide

A. Administration of albumin

A patient with cirrhosis of the liver is admitted to the hospital. What hematologic symptoms might be noted in this patient? Select all that apply. A. Anemia B. Leukemia C. Leukopenia D. Polycythemia vera E. Thrombocytopenia

A. Anemia C. Leukopenia E. Thrombocytopenia

A patient with ascites is admitted to the hospital. What should be the primary nursing actions in this case? Select all that apply. A. Anticipate paracentesis. B. Provide a high-sodium diet. C. Encourage high-fluid intake. D. Monitor fluid and electrolytes. E. Administer an albumin infusion.

A. Anticipate paracentesis. D. Monitor fluid and electrolytes. E. Administer an albumin infusion.

A patient comes with sudden and severe pain in the left upper quadrant of the abdomen and radiating to the back. Pain is aggravated by eating and is not relieved by vomiting. What priority action should the nurse take in this situation? A. Avoid oral intake of food. B. Give small, frequent oral feedings. C. Avoid giving spicy and fat-containing food. D. Identify food products that aggravate the pain and avoid them.

A. Avoid oral intake of food.

The nurse is caring for a patient with hepatitis C. What steps regarding nutrition can the nurse take to ensure that the patient gets the best nutrition possible? Select all that apply. A. Avoid very hot or very cold foods. B. Provide the patient with more liquid foods such as soups. C. Ensure that the patient drinks at least 2500-3000 mL of water every day. D. Ensure that the patient has a good breakfast and small or moderate dinner. E. Provide the patient with only raw foods such as fruits and salads until healthy.

A. Avoid very hot or very cold foods. C. Ensure that the patient drinks at least 2500-3000 mL of water every day. D. Ensure that the patient has a good breakfast and small or moderate dinner.

A patient comes to the ambulatory clinic with complications of cirrhosis. On examination, the patient's abdomen is distended and has a shifting fluid wave. Which instructions should be included in the education for this patient? Select all that apply. A. Avoidance of alcohol B. Referral to nephrology C. A sodium-restricted diet D. The side effects of lactulose E. The side effects of spironolactone

A. Avoidance of alcohol C. A sodium-restricted diet D. The side effects of lactulose E. The side effects of spironolactone

The nurse suspects that a patient with cholelithiasis has developed choledocholithiasis. Increases in which assessment finding support the nurse's suspicion? Select all that apply. A. Bilirubin B. Creatinine C. Platelet count D. Body temperature E. Alkaline phosphatase

A. Bilirubin D. Body temperature

A patient experiences severe pain in the right upper quadrant of the abdomen, increased heart rate, and shortness of breath. The nurse suspects that the consumption of what food items caused the patient's symptoms? Select all that apply. A. Cheese B. Buttermilk C. Hamburger D. Sugar cookie E. Carbonated beverage

A. Cheese C. Hamburger

A patient with cancer of the head of the pancreas is admitted to the hospital. What are the manifestations that a nurse might expect to find in this patient? Select all that apply. A. Clay-colored stools B. Itching and irritation of the skin C. Ulcers on the back and abdomen D. Swelling of the face and extremities E. Extreme pain in the upper abdomen that may radiate to the back

A. Clay-colored stools B. Itching and irritation of the skin E. Extreme pain in the upper abdomen that may radiate to the back

A patient underwent pancreaticoduodenectomy (Whipple procedure) for pancreatic cancer. What are the instructions that the nurse should include when giving dietary advice to this patient? Select all that apply. A. Consume a low-fat diet. B. Consume a high-calorie diet. C. Consume a diet high in proteins. D. Consume a low-carbohydrate diet. E. Patient may resume normal diet without any restrictions.

A. Consume a low-fat diet. B. Consume a high-calorie diet. C. Consume a diet high in proteins.

A patient with a chronic hepatitis C virus (HCV) infection is admitted to the hospital. What are the factors that contribute to a high risk for development of cirrhosis of the liver in this patient? Select all that apply. A. Diabetes mellitus B. Alcohol consumption C. History of regular smoking D. Elevated levels of cholesterol E. Diet high in sodium and fatty foods

A. Diabetes mellitus B. Alcohol consumption D. Elevated levels of cholesterol

A patient has just undergone a liver transplant and is now in the intensive care unit (ICU). What nursing interventions are appropriate for this patient to prevent respiratory complications? Select all that apply. A. Encourage the patient to cough. B. Consider repositioning the patient. C. Instruct the patient to walk around the bed. D. Encourage the patient to take deep breaths. E. Administer cough suppressants to prevent coughing.

A. Encourage the patient to cough. B. Consider repositioning the patient. D. Encourage the patient to take deep breaths.

A patient is advised to undergo laparoscopic cholecystectomy. The patient asks the nurse what exactly this procedure means. What are the points that a nurse can include in this explanation? Select all that apply. A. Gallbladder is removed through 1 to 4 small punctures on the abdominal wall. B. Gallbladder is removed through an incision made on the right subcostal region. C. The procedure is done with a laparoscope and grasping forceps under anesthesia. D. The patient can be discharged on the day of operation or the next and resume his work after a week. E. The gallbladder is removed through an incision on the abdomen, and a catheter is inserted to drain any fluids or effusion.

A. Gallbladder is removed through 1 to 4 small punctures on the abdominal wall. C. The procedure is done with a laparoscope and grasping forceps under anesthesia. D. The patient can be discharged on the day of operation or the next and resume his work after a week.

A patient arrives in the emergency department with acute abdominal pain related to acute pancreatitis. What does the nurse recognize may cause this disorder? Select all that apply. A. Gallstones B. Cystic fibrosis C. Alcohol abuse D. Isoniazid therapy E. Food contaminated by feces

A. Gallstones B. Cystic fibrosis C. Alcohol abuse

Which interventions does the nurse include in the care plan of a patient with pancreatitis who is on dicyclomine therapy? A. Give plenty of fluids. B. Follow fluid restrictions. C. Do not apply lotion to the skin. D. Give cool mist vapors through the nasal passages.

A. Give plenty of fluids.

A patient reports vomiting, nausea, and joint pain. An IgM antibody test has been prescribed. The nurse suspects what diagnosis? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D

A. Hepatitis A

The nurse is caring for a patient with a suspected pancreatic abscess. What clinical manifestations should the nurse document that correlates with the diagnosis? Select all that apply. A. High fever B. Steatorrhea C. Leukocytosis D. Chvostek's sign E. Abdominal pain

A. High fever C. Leukocytosis E. Abdominal pain

While caring for a patient with pancreatitis, a nurse observes that the patient is irritable, has jerking movements, and reports a loss of sensation in the fingers. Which electrolyte abnormality does the nurse suspect? Select all that apply. A. Hypocalcemia B. Hypoglycemia C. Hyponatremia D. Hypomagnesemia E. Increased serum amylase

A. Hypocalcemia D. Hypomagnesemia

The nurse is caring for a patient with pancreatitis who is on a regular diet. Which finding indicates to the nurse that food and fluids should be withheld for this patient? A. Increased pain B. Decreased abdominal girth C. Decreased serum lipase levels D. Decreased serum amylase levels

A. Increased pain

What is appropriate for the nurse to include when teaching a student nurse about open cholecystectomy? A. It involves insertion of a T-tube following surgery. B. It involves insertion of a needle into the core of the tumor. C. It involves resection of the proximal pancreas and duodenum. D. It involves administration of an embolic agent through a catheter.

A. It involves insertion of a T-tube following surgery.

A patient has been diagnosed with cholelithiasis. The nurse will monitor for manifestations of obstructed bile flow, including which of these? Select all that apply. A. Jaundice B. Steatorrhea C. Dark, tarry stools D. Dark, amber urine E. Bleeding tendencies

A. Jaundice B. Steatorrhea D. Dark, amber urine E. Bleeding tendencies

A patient is admitted to the acute care facility with a diagnosis of acute severe pancreatitis. What clinical manifestations of severe pancreatitis does the nurse monitor? Select all that apply. A. Jaundice B. Spider angiomas C. Thrombocytopenia D. Pancreatic necrosis E. Decrease in exocrine function

A. Jaundice D. Pancreatic necrosis E. Decrease in exocrine function

An elderly woman reports weakness, abdominal pain, and bleeding from the vagina. When reviewing the patient's diagnostic test reports, the nurse notes anemia and an enlarged spleen. The nurse suspects that the patient has what condition? A. Liver cirrhosis B. Pancreatic cancer C. Acute liver failure D. Acute pancreatitis

A. Liver cirrhosis

A nurse is collecting data from a patient admitted with hepatitis A. Which information given by the patient may indicate the patient's susceptibility to contract hepatitis A? Select all that apply. A. Living in slums B. Working as local plumber C. Working in a chemical factory D. Working as a sewage cleaner E. Working as a waiter and dishwasher

A. Living in slums B. Working as local plumber D. Working as a sewage cleaner

The nurse should recommend what type of diet for a patient with acute cholecystitis? A. Low-fat B. Low-protein C. Low-calcium D. Low-carbohydrate

A. Low-fat

A patient has undergone cholecystectomy. What postoperative care should the nurse perform for this patient? Select all that apply. A. Maintain a low-fat diet. B. Monitor for any bleeding. C. Place patient in shock position. D. Instruct not to do deep breathing. E. Place the patient in Sims' position.

A. Maintain a low-fat diet. B. Monitor for any bleeding. E. Place the patient in Sims' position.

Which conditions in a patient with liver dysfunction may cause a percutaneous liver biopsy to have to be rescheduled? Select all that apply. A. Marked ascites B. Chronic hepatitis C. Hepatic cirrhosis D. Bleeding disorder E. Low hemoglobin level

A. Marked ascites D. Bleeding disorder E. Low hemoglobin level

A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge? A. Milk thistle may affect liver enzymes and thus alter drug metabolism. B. Milk thistle generally is safe in recommended doses for up to 10 years. C. There is unclear scientific evidence for the use of milk thistle in treating cirrhosis. D. Milk thistle may elevate the serum glucose levels and thus is contraindicated in diabetes.

A. Milk thistle may affect liver enzymes and thus alter drug metabolism.

A nurse is caring for a patient with pancreatitis. Which interventions should the nurse implement while taking care of the patient? Select all that apply. A. Monitor calcium levels. B. Monitor prothrombin time. C. Monitor magnesium levels. D. Monitor blood glucose levels. E. Monitor blood urea nitrogen levels.

A. Monitor calcium levels. C. Monitor magnesium levels. D. Monitor blood glucose levels.

While caring for a patient with gallbladder disease, the nurse notes that the patient experiences frequent episodes of severe vomiting. What is appropriate to be included in the patient's plan of care? Select all that apply. A. Monitor vital signs. B. Rinse the mouth daily. C. Perform gastric decompression. D. Place the patient on a low-fat diet. E. Instruct the patient to gargle with salt water before every meal.

A. Monitor vital signs. C. Perform gastric decompression. D. Place the patient on a low-fat diet.

Which type of monitoring should the nurse include in the care plan of a patient with cholecystitis? A. Monitoring gums for bleeding B. Monitoring blood glucose levels C. Monitoring serum albumin levels D. Monitoring serum creatinine levels

A. Monitoring gums for bleeding

A patient with acute pancreatitis reports severe abdominal pain. What medication does the nurse anticipate administering to the patient to alleviate the pain? A. Morphine B. Omeprazole C. Pancrelipase D. Acetazolamide

A. Morphine

A patient returns to the surgical center 10 days after a cholecystectomy for his postoperative checkup. His wife is with him and is asking whether she should be concerned about having cholelithiasis as well. What is the most appropriate response by the nurse? A. Obesity increases the risk, especially in women. B. Pregnancy is not a risk factor for cholelithiasis in women. C. The incidence of cholelithiasis is lower in women than in men. D. Gender differences in the incidence decrease after 40 years of age.

A. Obesity increases the risk, especially in women.

Which action of the student nurse indicates effective learning about determining the effectiveness of pancreatic enzymes replacement in patients with chronic pancreatitis? A. Observing the patient's stool B. Observing the patient's urine C. Observing the patient's saliva D. Observing the patient's nasal secretions

A. Observing the patient's stool

The nurse is caring for a patient who has an increase in gastric acid that is causing epigastric pain. Which drug does the nurse anticipate administering to the patient to reduce the gastric acid secretion? A. Omeprazole B. Dicyclomine C. Nitroglycerin D. Acetazolamide

A. Omeprazole

The nurse collects data on a group of patients and suspects that which patient has cirrhosis? A. Patient A B. Patient B C. Patient C D. Patient D

A. Patient A

The nurse reviews the medication records for a group of patients. The nurse should question the medication that has been prescribed for which patient? A. Patient A B. Patient B C. Patient C D. Patient D

A. Patient A

Which patient's medication chart needs correction? A. Patient A B. Patient B C. Patient C D. Patient D

A. Patient A

Which assessment findings are associated with complications of cirrhosis of the liver? Select all that apply. A. Pedal edema B. Productive cough C. Mental status changes D. Black, tarry stools E. Chest pain with diaphoresis

A. Pedal edema C. Mental status changes D. Black, tarry stools

The nurse is providing discharge instructions to a patient that has undergone a laparoscopic cholecystectomy. What is appropriate for the nurse to include in the teaching? Select all that apply. A. Record daily weights. B. Eat foods rich in fatty acids. C. Eat a heavy meal during lunch. D. Add fiber-rich foods to the diet. E. Eat small meals and two to three snacks each day.

A. Record daily weights. D. Add fiber-rich foods to the diet. E. Eat small meals and two to three snacks each day.

While caring for a patient with chronic pancreatitis, a primary health care provider orders the nurse to administer nortriptyline. What beneficial effect of nortriptyline will the nurse monitor in this patient? A. Reduction in neuropathic pain B. Normalization of blood glucose C. Decreased nausea and vomiting D. Improved digestion of fatty foods

A. Reduction in neuropathic pain

A patient with pancreatic cancer is in the outpatient cancer center to receive radiation therapy. The nurse knows that radiation therapy for patients with pancreatic cancer is to do what? A. Relieve pain B. Reduce ascites C. Increase survival time D. Inhibit tumor metastasis

A. Relieve pain

A patient who has undergone laparoscopic cholecystectomy reports difficulty breathing. The nurse suspects that which patient activity is contributing to this difficulty? A. Resting in the supine position B. Sleeping for prolonged periods C. Performing isometric exercises D. Performing deep-breathing exercises

A. Resting in the supine position

The nurse is providing discharge instructions to a patient and caregiver following a laparoscopic cholecystectomy. Which of these measures will be included in the discharge counseling? Select all that apply. A. Resume normal activities gradually within one week. B. Eat a low-fat diet for several weeks after the surgery. C. Keep the bandages on the puncture sites for three days. D. Report any bile-colored drainage or pus from any incision. E. Empty and measure the contents of the bile bag from the T tube every day.

A. Resume normal activities gradually within one week. B. Eat a low-fat diet for several weeks after the surgery. D. Report any bile-colored drainage or pus from any incision.

The nurse needs to determine whether a patient is being compliant with the medication regimen for the treatment of pancreatitis. What type of sample should the nurse collect in order to see if the patient has steatorrhea? A. Stool B. Urine C. Blood D. Sputum

A. Stool

The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons? Select all that apply. A. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. B. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. C. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity. D. Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluids orally. E. Overactivity of the enlarged spleen results in increased removal of blood cells from circulation, which decreases vascular pressure.

A. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. B. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. C. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.

Which condition is associated with the formation of stones in the gallbladder? A. Biliary colic B. Cholangitis C. Cholecystitis D. Cholelithiasis

D. Cholelithiasis

What points should a nurse emphasize while teaching a patient ways to protect oneself from exposure to hepatitis B infection? Select all that apply. A. Use disposable needles and syringes. B. Avoid sharing toothbrushes and razors. C. Avoid eating food prepared in unhygienic ways. D. Avoid touching or coming in contact with people with hepatitis B. E. Avoid unsafe sex with multiple partners, and always use condoms.

A. Use disposable needles and syringes. B. Avoid sharing toothbrushes and razors. E. Avoid unsafe sex with multiple partners, and always use condoms.

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome? Select all that apply. A. Use smallest gauge needle possible when giving injections or drawing blood. B. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. C. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. D. Apply gentle pressure for the shortest possible time period after performing venipuncture. E. Instruct patient to avoid aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) to prevent hemorrhage when varices are present.

A. Use smallest gauge needle possible when giving injections or drawing blood. B. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. C. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. E. Instruct patient to avoid aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) to prevent hemorrhage when varices are present.

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements? Select all that apply. A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K E. Vitamin B

A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K

The nurse finds that a patient admitted to the hospital with cirrhosis of the liver is disoriented, lethargic, and drowsy and has abnormal reflexes. Based on the patient's signs and symptoms, the nurse understands that the patient is in grade hepatic encephalopathy. Fill in the blank using a whole number.

A: 2

The nurse recalls that which substance is involved in the development of cholelithiasis? A. Albumin B. Calcium C. Sodium D. Globulin

B. Calcium

The nurse notes that a patient is scheduled for a gallbladder removal. The patient will sign a consent form for what procedure? A. Splenectomy B. Cholecystectomy C. Cholecystojejunostomy D. Pancreaticoduodectomy

B. Cholecystectomy

The nurse provides education to a patient about postoperative care after an open cholecystectomy. Which statement made by the patient indicates the need for further teaching? A. "I should consume a low-fat diet." B. "I am permitted to resume weightlifting." C. "I am permitted to engage in sexual intercourse." D. "It is important to perform deep-breathing exercises."

B. "I am permitted to resume weightlifting."

The nurse provides discharge instructions to a patient with newly diagnosed cirrhosis. Which statement made by the patient indicates the need for further teaching? A. "I should take frequent rest periods." B. "I can eat anything that appeals to me." C. "I can do without my glass of wine with dinner." D. "I should take only medications that have been prescribed."

B. "I can eat anything that appeals to me."

A nurse is providing dietary instructions to a patient with pancreatitis. Which statement by the patient indicates the need for further teaching? A. "I should avoid fat-rich foods." B. "I should avoid fiber-rich foods." C. "I should eat protein-rich foods." D. "I should eat carbohydrate-rich foods."

B. "I should avoid fiber-rich foods."

The nurse provides education to a student nurse about cholecystitis management. Which statement made by the student nurse indicates the need for further teaching? A. "Ketorolac is prescribed to reduce abdominal pain." B. "Octreotide is prescribed to reduce smooth muscle spasms." C. "Nasogastric intubation is performed to relieve nausea and vomiting." D. "A cholecystostomy is performed to remove pus from the gallbladder."

B. "Octreotide is prescribed to reduce smooth muscle spasms."

A patient is diagnosed with acute pancreatitis. Which enzyme is responsible for autodigestion of the pancreas and leads to bleeding in this patient? A. Enterokinase B. Activated trypsin C. Alkaline phosphatase D. Alanine aminotransferase

B. Activated trypsin

A parent brings a child to a primary health care center and reports that the child has abdominal pain, back pain, and fever. The nurse assesses that the child has diminished bowel sounds and a bluish discoloration adjacent to the navel. What does the nurse anticipate the child will be treated for? A. Pancreatic cyst B. Acute pancreatitis C. Pancreatic abscess D. Chronic pancreatitis

B. Acute pancreatitis

Which intervention should a nurse implement to reduce discomfort in a patient with acute pancreatitis who complains of discomfort due to abdominal pain? Select all that apply. A. Give 300 mL of water. B. Administer morphine. C. Give an abdominal massage. D. Encourage the patient to go for a walk. E. Encourage the patient to change position frequently.

B. Administer morphine. E. Encourage the patient to change position frequently.

The nurse interviewing a patient with acute pancreatitis expects what finding in the patient's history? A. COPD B. Alcohol abuse C. Diabetes mellitus D. Congestive heart failure

B. Alcohol abuse

Which assessment finding would the nurse expect in a patient with an increased ammonia level associated with hepatic encephalopathy? A. Aphasia B. Asterixis C. Hyperactivity D. Acute dementia

B. Asterixis

What is the name of the substance that is a mixture of cholesterol crystals and calcium salts that may be found in a patient diagnosed with pancreatitis? A. Apraxia B. Biliary sludge C. Biliary atresia D. Pancreatic abscess

B. Biliary sludge

The nurse caring for a patient who has undergone cholecystectomy should monitor the patient for which major immediate postoperative complication? A. Infection B. Bleeding C. Dehydration D. Bowel obstruction

B. Bleeding

The parent of a pediatric patient suffering from hepatitis A approaches the nurse and is worried about the spread of infection to other family members through use of the same bathroom. What should the nurse advise the patient's parent? Select all that apply. A. Buy a separate commode for your son. B. Clean the bathroom and commode thoroughly. C. There is no need for concern; just use disposable toilet covers. D. Ask your son to wash his hands thoroughly after using the bathroom. E. Ask all other family members to wash their hands thoroughly before eating and after using the bathroom.

B. Clean the bathroom and commode thoroughly. D. Ask your son to wash his hands thoroughly after using the bathroom. E. Ask all other family members to wash their hands thoroughly before eating and after using the bathroom.

A patient is diagnosed with acute pancreatitis. When providing dietary teaching, what are the points that a nurse should tell the patient? Select all that apply. A. Limit fluid intake. B. Consume a low-fat diet. C. Avoid consuming alcohol. D. Consume a low-carbohydrate diet. E. Consume a high-carbohydrate diet.

B. Consume a low-fat diet. C. Avoid consuming alcohol. E. Consume a high-carbohydrate diet.

The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient? A. Prevent all oral intake B. Control abdominal pain C. Provide enteral feedings D. Avoid dietary cholesterol

B. Control abdominal pain

The nurse is performing an assessment on a patient that has been admitted with severe pancreatitis and discovers a bluish discoloration of the periumbilical area. How should the nurse document this finding? A. Asterixis B. Cullen's sign C. Spider angioma D. Grey Turner's sign

B. Cullen's sign

The nurse is reviewing the laboratory studies for a patient with acute pancreatitis. Which abnormal finding does the nurse report that is seen in acute pancreatitis? A. Decreased serum lipase B. Decreased serum calcium C. Decreased serum amylase D. Decreased serum triglycerides

B. Decreased serum calcium

What are the precautions that nurses and hospital staff should follow while handling patients suffering from hepatitis infections? Select all that apply. A. The patient must be in a private room, and door should be closed. B. Dispose of the needles and syringes used on the patient carefully. C. Wear gloves while handling articles contaminated by urine or feces. D. Always wear a mask, gown, and gloves when entering the patient's room. E. Follow infection control precautions while injecting the patient, and avoid getting pricked by the used needle.

B. Dispose of the needles and syringes used on the patient carefully. C. Wear gloves while handling articles contaminated by urine or feces. E. Follow infection control precautions while injecting the patient, and avoid getting pricked by the used needle.

While caring for a patient with pancreatitis, a nurse finds that the patient's blood pressure dropped to 90/60 mm Hg from an initial baseline of 125/80 mm Hg. The nurse administers isotonic fluid. Which medication should the nurse administer as prescribed by the primary health care provider? A. Morphine B. Dopamine C. Omeprazole D. Pancrelipase

B. Dopamine

Which intervention should the nurse implement to reduce the risk of parotitis in a patient with pancreatitis? A. Encourage the patient to perform hand hygiene. B. Encourage the patient to rinse his or her mouth frequently. C. Encourage the patient to moisturize hands before sleeping. D. Encourage the patient to practice deep-breathing exercises.

B. Encourage the patient to rinse his or her mouth frequently.

A patient is diagnosed with chronic cholecystitis. The nurse expects what assessment finding? A. Urticaria B. Flatulence C. Indigestion D. Weight loss

B. Flatulence

During follow-up visits, a nurse finds that the patient is having an exacerbation of pancreatitis. Which action of the patient's caregiver is responsible for this condition? A. Giving Creon along with meals B. Giving three large meals a day C. Checking for fatty stools in the patient D. Giving omeprazole one hour after meals

B. Giving three large meals a day

A patient suffering from cholelithiasis underwent a cholecystectomy. What dietary advice will the nurse give this patient? Select all that apply. A. Limit intake of water. B. Have a high-fiber diet. C. Have the same diet as before. D. Have small but frequent meals. E. Avoid or keep fats to a minimum.

B. Have a high-fiber diet. D. Have small but frequent meals. E. Avoid or keep fats to a minimum.

Which hepatitis virus is transmitted parenterally from mother to fetus? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis E

B. Hepatitis B

What are the clinical manifestations of chronic hepatitis? Select all that apply. A. Bilirubinuria B. Hepatomegaly C. Nausea and vomiting D. Elevated liver enzymes E. Decreased sense of taste

B. Hepatomegaly D. Elevated liver enzymes

The nurse is planning discharge teaching for a patient after a laser laparoscopic cholecystectomy. The nurse explains to the patient about self-care at home. Which statements of the patient indicate that the patient has understood the discharge teachings? Select all that apply. A. I cannot bathe or shower for 10 days. B. I can have normal food that is low in fat. C. I may have mild shoulder pain for a week. D. I should not lift heavy weights for a few days. E. I should have only a liquid diet for the first week.

B. I can have normal food that is low in fat. C. I may have mild shoulder pain for a week. D. I should not lift heavy weights for a few days.

The patient with advanced cirrhosis asks why his or her skin is so yellow. The nurse's response is based on what knowledge? A. Decreased peristalsis in the gastrointestinal tract contributes to a buildup of bile salts. B. Jaundice results from the body's inability to conjugate and excrete bilirubin. C. A lack of clotting factors promotes the collection of blood under the skin surface. D. Decreased colloidal oncotic pressure from hypoalbuminemia causes the yellowish skin discoloration.

B. Jaundice results from the body's inability to conjugate and excrete bilirubin.

The nurse is developing a plan of care for a patient with acute pancreatitis. What nursing actions should be included in the plan of care? Select all that apply. A. Observe for skin irritation. B. Monitor electrolyte levels. C. Assess respiratory function. D. Provide psychologic support. E. Observe for muscular twitching.

B. Monitor electrolyte levels. C. Assess respiratory function. E. Observe for muscular twitching.

The nurse is providing immediate post-procedural care to a patient who underwent endoscopic retrograde cholangiopancreatography (ERCP). Which actions by the nurse are beneficial to the patient? Select all that apply. A. Providing oral foods B. Observing for signs of bleeding C. Maintaining the patient on bed rest D. Observing for any change in body temperature E. Encouraging the patient to drink plenty of fluids

B. Observing for signs of bleeding C. Maintaining the patient on bed rest D. Observing for any change in body temperature

The nurse is providing postoperative care to a patient who underwent open cholecystectomy three days ago. Which finding during the nurse's assessment should prompt the nurse to notify the primary health care provider? A. Tolerance of a full-liquid diet B. Oral temperature of 101.8° F C. Report of pain at a level 5 on a scale of 0 to 10 D. An 8-hour fluid intake of 680 mL and an output of 660 mL

B. Oral temperature of 101.8° F

A student nurse is preparing a medication chart for a group of patients. Which patient's medication chart needs correction? A. Patient A B. Patient B C. Patient C D. Patient D

B. Patient B

The nurse reviews medication prescriptions for four patients. The nurse should question which patient's prescription? A. Patient A B. Patient B C. Patient C D. Patient D

B. Patient B

The nurse reviews the medication records for a group of patients. The nurse should question which patient's prescription? A. Patient A B. Patient B C. Patient C D. Patient D

B. Patient B

A patient suffering from ascites is admitted to the hospital. What are the factors that can lead to ascites development? Select all that apply. A. Diabetes mellitus B. Portal hypertension C. Hyperaldosteronism D. Decreased flow of hepatic lymph E. Decreased serum colloidal oncotic pressure

B. Portal hypertension C. Hyperaldosteronism E. Decreased serum colloidal oncotic pressure

The patient's ultrasound scan reveals acute cholecystitis. The patient is fearful of undergoing surgery and wants to try conservative management before consenting to a laparoscopic cholecystectomy. What orders should the nurse expect the physician to place in preparation for conservative management? Select all that apply. A. A regular diet B. Repeat complete blood count C. Immediate insertion of a nasogastric tube D. 2 mg intravenous hydromorphone every 6 hours as needed for pain E. 4 mg intravenous ondansetron every 6 hours for nausea and vomiting

B. Repeat complete blood count D. 2 mg intravenous hydromorphone every 6 hours as needed for pain E. 4 mg intravenous ondansetron every 6 hours for nausea and vomiting

What gallbladder change is associated with an acute attack of cholecystitis? A. A fistula B. Scarring C. Occlusion of the cystic duct D. Inflammation of the biliary duct

B. Scarring

The nurse is attending to a patient with tentative diagnosis of acute pancreatitis. Which diagnostic tests should the nurse anticipate for the health care provider to prescribe to confirm the diagnosis? Select all that apply. A. Liver biopsy B. Serum lipase C. Serum amylase D. Serum alpha-fetoproteins E. Computed tomography (CT) scan

B. Serum lipase C. Serum amylase E. Computed tomography (CT) scan

A female patient expresses her concern about becoming pregnant while her partner is on ribavirin therapy for chronic hepatitis C. What should the nurse advise the patient? A. She can plan pregnancy now. B. She should avoid getting pregnant now. C. She should not get pregnant with this partner ever. D. She should avoid any sexual intercourse after conception.

B. She should avoid getting pregnant now.

A patient reports loss of appetite, nausea, and vomiting. Laboratory test results reveal darkened urine and a positive hepatitis C antibody test. Which medication does the nurse anticipate will be prescribed? A. Adefovir B. Simeprevir C. Tenofovir D. Entecavir

B. Simeprevir

A patient with cirrhosis of the liver is on furosemide. The nurse should monitor the patient for which findings to prevent complications of diuretic therapy? Select all that apply. A. Lethargy B. Tachycardia C. Hypotension D. Hypertension E. Muscle weakness F. Cardiac arrhythmias

B. Tachycardia C. Hypotension E. Muscle weakness F. Cardiac arrhythmias

The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation? A. The patient has completed a college education. B. The chest x-ray showed another lung cancer lesion. C. The patient has been able to stop smoking cigarettes. D. The patient has well controlled type 1 diabetes mellitus.

B. The chest x-ray showed another lung cancer lesion.

The nurse recalls that patients with cholelithiasis experience pruritus due to what reason? A. The solubility of bilirubin in urine B. The deposition of bile salts in tissues C. The bile not flowing into the duodenum D. The decreased absorption of vitamin K

B. The deposition of bile salts in tissues

A primary health care provider orders nasojejunal tube feeding for a patient with acute pancreatitis. What does the nurse suspect to be the reason behind ordering enteral feeding rather than intravenous parental nutrition? A. To ensure fast absorption B. To prevent risk of infection C. To reduce patient's noncompliance D. To ensure easy insertion of the tube

B. To prevent risk of infection

The nurse recalls that bile salts in the body help with what function? A. Protein metabolism B. Vitamin absorption C. Glucose metabolism D. Ammonia elimination

B. Vitamin absorption

Which statements of the student nurse indicate effective learning about providing care to a patient with acute pancreatitis? Select all that apply. A. "I should encourage the patient to tolerate pain." B. "I should encourage the patient to limit fluid intake." C. "I should monitor the patient's blood glucose levels." D. "I should check for spider angioma on the patient's skin." E. "I should check the patient's body temperature twice a day."

C. "I should monitor the patient's blood glucose levels." E. "I should check the patient's body temperature twice a day."

The nurse provides education to a patient about laparoscopic cholecystectomy. Which statement made by the patient indicates the need for further teaching? A. "Small punctures will be made into my abdomen." B. "I may be discharged the same day as the surgery." C. "I will have work restrictions for 4 to 6 weeks after the surgery." D. "An instrument with a camera attached is inserted into the abdomen."

C. "I will have work restrictions for 4 to 6 weeks after the surgery."

The nurse is teaching a student nurse about postoperative care for a patient that has undergone laparoscopic cholecystectomy. Which statements made by the student nurse indicate the need for further teaching? Select all that apply. A. "I will monitor for bleeding." B. "I will encourage the patient to practice deep breathing." C. "I will most likely need to administer narcotics for pain control." D. "The patient will use a bedside commode for the first 24 hours after surgery." E. "The patient will need to return to the office in 7 to 10 days for removal of stitches."

C. "I will most likely need to administer narcotics for pain control." D. "The patient will use a bedside commode for the first 24 hours after surgery." E. "The patient will need to return to the office in 7 to 10 days for removal of stitches."

What is the average incubation period of the hepatitis E virus? A. 28 days B. 56 days C. 26 to 42 days D. 56 to 96 days

C. 26 to 42 days

When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include? A. Do not return to work or normal activities for three weeks. B. Bile-colored drainage probably will drain from the incision. C. A lower-fat diet may be tolerated better for several weeks. D. Keep the bandages on and the puncture site dry until it heals.

C. A lower-fat diet may be tolerated better for several weeks.

A patient with cancer that has metastasized to the liver manifests symptoms of fluid retention, including edema and ascites. To determine the effectiveness of the diuretic therapy that has been prescribed, what should the nurse assess? A. Breath sounds B. Bowel sounds C. Abdominal girth D. Recent blood work

C. Abdominal girth

The nurse evaluates the effectiveness of a paracentesis in a patient who has ascites. Which measurement is most important for the nurse to note? A. Cardiac output B. Blood pressure C. Abdominal girth D. Intake and output

C. Abdominal girth

The nurse expects what physical finding in a patient with cholecystitis? A. Spider angioma B. Flapping tremors C. Abdominal rigidity D. Grey Turner's sign

C. Abdominal rigidity

The nurse is reviewing the laboratory reports of a patient who was admitted with sudden onset severe abdominal pain. After reviewing these results, the nurse suspects that the patient may have which disorder? Refer to chart. A. Liver cirrhosis B. Acute hepatitis C. Acute pancreatitis D. Chronic pancreatitis

C. Acute pancreatitis

A patient has been admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse. Laboratory results are significant for an alanine aminotransferase (ALT) of 198 IU/L and aspartate transaminase (AST) of 224 IU/L. Which diagnosis does the nurse attribute these findings to? A. Malnutrition B. Osteomyelitis C. Alcohol abuse D. Diabetes mellitus

C. Alcohol abuse

The nurse is admitting a patient with cirrhosis. The nurse checks the patient's history for which most frequent risk factor associated with cirrhosis? A. Hepatitis A B. Polypharmacy C. Alcohol abuse D. Intravenous drug abuse

C. Alcohol abuse

The nurse recalls that hepatic coma results primarily from accumulation of which substance in the blood? A. Sodium B. Calcium C. Ammonia D. Potassium

C. Ammonia

A patient with acute hepatitis B will be discharged tomorrow. The nurse should include which measures in the discharge teaching plan? Select all that apply. A. Restrict fluid intake. B. Avoid alcohol for the first three weeks. C. Avoid foods that are very hot or very cold. D. Be sure to allow for periods of rest during the day. E. Participate in an exercise regimen to build stamina. F. Eat small meals frequently rather than three times a day.

C. Avoid foods that are very hot or very cold. D. Be sure to allow for periods of rest during the day. F. Eat small meals frequently rather than three times a day.

The nurse is caring for a patient four days after the patient experienced food poisoning. Admission assessment findings include abdominal pain associated with restlessness, elevated liver enzyme levels, increased direct and indirect bilirubin levels, and an increased white blood count. The nurse suspects what diagnosis? A. Liver cirrhosis B. Acute liver failure C. Bile flow obstruction D. Hepatic encephalopathy

C. Bile flow obstruction

What is the cause of the formation of biliary sludge? A. Ascites B. Hepatitis C. Bile stasis D. Biliary colic

C. Bile stasis

A nurse assessing a patient with pancreatitis suspects the presence of Grey Turner's sign when the patient exhibits what? A. Jaundice of the sclera B. Bluish discoloration of the flank area C. Bluish discoloration of the periumbilical area D. Left abdominal pain that occurs with movement

C. Bluish discoloration of the periumbilical area

The nurse finds that a patient with cholelithiasis is experiencing severe itching. The laboratory findings reveal a 2.1 mg/dL bilirubin level. The nurse expects that which medication will be prescribed? A. Nadolol B. Lactulose C. Vasopressin D. Cholestyramine

D. Cholestyramine

The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment? A. Abdominal ultrasound B. Spiral computed tomography (CT) scan C. Cancer-associated antigen 19-9 (CA 19-9) D. A positron emission tomography (PET)/CT scan

C. Cancer-associated antigen 19-9 (CA 19-9)

A patient presents with pain in the right side of the upper quadrant, a body temperature of 101° F, and indigestion. The laboratory reports show a white blood cell count (WBC) of 14,000 cells/μL. The nurse suspects that the patient is experiencing which condition? A. Cirrhosis B. Pancreatitis C. Cholecystitis D. Pancreatic cancer

C. Cholecystitis

A patient reports abdominal pain. Upon assessment, the nurse finds the presence of tachycardia and prostration. Which condition does the nurse suspect that the patient is experiencing? A. Pancreatitis B. Cholecystitis C. Cholelithiasis D. Liver cirrhosis

C. Cholelithiasis

The nurse reviews a patient's laboratory values and recognizes which finding as an indication of resolution of acute pancreatitis? A. Increasing hemoglobin level B. Falling serum bilirubin level C. Decreasing serum amylase level D. Increasing serum alkaline phosphatase level

C. Decreasing serum amylase level

The nurse recalls that which condition is associated with acalculous cholecystitis? A. Cholangitis B. Choledolithiasis C. Diabetes mellitus D. Acute pancreatitis

C. Diabetes mellitus

A patient is diagnosed with mild pancreatitis. What condition does the nurse recognize correlates with this diagnosis? A. Pancreatic failure B. Pancreatic necrosis C. Edematous pancreas D. Sepsis of the pancreas

C. Edematous pancreas

A patient with type 2 diabetes mellitus has been diagnosed with non-alcoholic fatty liver disease (NAFLD). The nursing teaching plan should include which of the following? A. Having genetic testing done B. Eliminating carbohydrates from the diet C. Following measures to gain tighter glucose control D. Avoiding alcohol until liver enzymes return to normal

C. Following measures to gain tighter glucose control

The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer? A. Serum α-fetoprotein level B. Ventilation/perfusion scan C. Hepatic structure ultrasound D. Abdominal girth measurement

C. Hepatic structure ultrasound

A patient with a history of alcohol abuse reports dull abdominal pain, yellowing eyes, nausea, and vomiting for three weeks. The laboratory report reveals that the patient has elevated serum levels of the liver enzymes and an increased level of serum alpha-fetoprotein. Which condition does the nurse suspect? A. Liver cirrhosis B. Acute liver failure C. Hepatocellular cancer D. Hepatic encephalopathy

C. Hepatocellular cancer

What dietary recommendation should the nurse give to a patient with chronic gallbladder disease? A. Include dairy products. B. Maintain a low-protein diet. C. Include fat-soluble vitamins. D. Increase the intake of refined cereals.

C. Include fat-soluble vitamins.

A patient reports nausea, a 5 kg weight loss in six days, and pain in the abdomen radiating to the back. After reviewing the magnetic resonance imaging (MRI) report, a primary health care provider orders a CA 19-9 test to confirm the diagnosis. Which condition is suspected? A. Cholecystitis B. Cholelithiasis C. Pancreatic cancer D. Acute pancreatitis

C. Pancreatic cancer

A patient reports nausea and pain in the abdomen. While examining the patient, a nurse notices bluish discoloration in the area between the last rib and the hip. The laboratory reports reveal a white blood cell count (WBC) of 12,000 cells/μL and a body temperature of 99.1° F. What does the nurse suspect may be occurring in this patient? A. Cirrhosis B. Liver failure C. Pancreatitis D. Cholecystitis

C. Pancreatitis

A patient who is receiving treatment for cholelithiasis experiences severe nausea and six episodes of vomiting. The nurse identifies that which intervention will be beneficial to the patient? A. Administrating lactulose B. Administrating rifaximin C. Performing gastric decompression D. Performing endotracheal intubation

C. Performing gastric decompression

Which nursing action should be performed immediately for a patient with acute pancreatitis who has developed acute respiratory distress syndrome (ARDS)? A. Infuse normal saline. B. Give chest compressions. C. Provide ventilator support. D. Call someone in the x-ray department to do a portable chest x-ray.

C. Provide ventilator support.

A patient's cholecystitis worsens overnight, and the patient is taken for a laparoscopic cholecystectomy. Upon returning to the medical-surgical unit, the patient begins to complain of shoulder pain, rated as an 8 out of 10 on the pain scale, and mild difficulty breathing. Which is the nurse's most appropriate action? A. Administer supplemental oxygen. B. Page the physician to report the patient's change in condition. C. Reassure and reposition the patient, and administer ordered analgesics. D. Perform an immediate electrocardiogram because this could be a sign of an impending cardiac event.

C. Reassure and reposition the patient, and administer ordered analgesics.

Which subjective description of pain does the nurse expect in a patient who has cholecystitis? A. Left flank pain with intermittent exacerbations B. Right lower quadrant pain with rebound tenderness C. Right upper quadrant pain radiating to the shoulder and scapula D. Epigastric pain that intensifies when the patient is lying down

C. Right upper quadrant pain radiating to the shoulder and scapula

A nurse is caring for a patient with cirrhosis of the liver. What clinical manifestations should the nurse expect to find upon physical examination? Select all that apply. A. White patches on skin B. Deposits of dark pigments C. Small areas of bleeding into the skin D. Vascular lesions formed by small blood vessels E. Small dilated blood vessels with spiderlike branches

C. Small areas of bleeding into the skin D. Vascular lesions formed by small blood vessels E. Small dilated blood vessels with spiderlike branches

A patient reports nausea, vomiting, and abdominal tenderness. The patient's laboratory reports reveal an erythrocyte sedimentation rate of 32 mm/hr, a white blood cell (WBC) count of 12,000/-μL, 2.2 mg/dL of bilirubin, and serum alkaline phosphatase of 120 U/L. What does the nurse suspect that this indicates? A. Cirrhosis B. Gallstones C. Liver cancer D. Chronic pancreatitis

D. Chronic pancreatitis

The nurse is preparing education for a group of student nurses about endoscopic retrograde cholangiopancreatography (ERCP). Which information is appropriate for the nurse to include in the teaching? Select all that apply. A. An endoscope is passed into the stomach. B. ERCP allows visualization of the stomach. C. The endoscope leaves the stone in the duodenum. D. ERCP is performed to create a stoma in the gallbladder. E. The stent associated with ERCP can be changed after a few months.

C. The endoscope leaves the stone in the duodenum. E. The stent associated with ERCP can be changed after a few months.

A patient with hepatitis A asks whether other family members are at risk for "catching" the disease. The nurse's response will be based on the knowledge that hepatitis A is transmitted primarily in which way? A. During sexual intercourse B. By contact with infected body secretions C. Through fecal contamination of food or water D. Through kissing that involves contact with mucous membranes

C. Through fecal contamination of food or water

A patient with hepatitis A infection is being discharged from the hospital. What is the most important instruction that the nurse should include in the discharge teaching? A. Do not share razors or toothbrushes. B. Isolate the patient from other family members. C. Wash hands carefully after bowel movements. D. Take acetaminophen every four hours if fever persists.

C. Wash hands carefully after bowel movements.

A patient, whose body temperature is 99° F, reports abdominal pain, nausea, vomiting, dark urine, and foul-smelling stool. The laboratory reports reveal increased levels of bilirubin in the blood. What does the nurse suspect this indicates? A. Liver cancer B. Acute liver failure C. Acute pancreatitis D. Chronic pancreatitis

D. Chronic pancreatitis

The nurse is caring for a patient with gallstones and expects what assessment finding? A. Tachycardia B. Hypotension C. Hyperglycemia D. Clay-colored stools

D. Clay-colored stools

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is most appropriate? A. "The hepatitis vaccine will provide immunity from this exposure and future exposures." B. "I am afraid there is nothing you can do because the patient was infectious before admission." C. "You will need to be tested first to make sure you don't have the virus before we can treat you." D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."

D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."

Which statement indicates a need for further teaching by a student nurse about nutritional therapy in patients with acute pancreatitis? A. "I should feed the patient through a nasojejunal tube." B. "I should monitor the patient's blood triglyceride levels." C. "I should give small quantities of food frequently to the patient." D. "I should include fat-rich food substances in the patient's dietary plan."

D. "I should include fat-rich food substances in the patient's dietary plan."

When teaching the male patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement? A. "I will need to take adefovir to prevent chronic HCV." B. "I will use care when kissing my wife to prevent giving it to her." C. "Now that I have had HCV, I will have immunity and not get it again." D. "I will need to be checked for chronic HCV and other liver problems."

D. "I will need to be checked for chronic HCV and other liver problems."

A patient is scheduled for a secretin stimulation test and asks the nurse what this will evaluate. What is the best response by the nurse? A. "It will evaluate if you have Wilson's disease." B. "It will evaluate if you have diabetes mellitus." C. "It will determine if you have acute pancreatitis." D. "It will determine if you have chronic pancreatitis."

D. "It will determine if you have chronic pancreatitis."

The nurse provides information to a student nurse about endoscopic retrograde cholangiopancreatography (ERCP). Which statement made by the student nurse indicates the need for further teaching? A. "It allows visualization of biliary system." B. "The electrodiathermy knife cuts up the stone." C. "An electrodiathermy knife is attached to the endoscope." D. "Oral dissolution therapy is used in conjunction with this procedure."

D. "Oral dissolution therapy is used in conjunction with this procedure."

The patient is scheduled for a q12hr dose of lactulose 30 grams orally. Available is an oral solution containing 5 g/10 mL. How much solution should be poured into the medication cup to give the required dose? A. 15 mL B. 30 mL C. 45 mL D. 60 mL

D. 60 mL

A patient reports abdominal pain and passing of greasy stools with foul odor. What does the nurse suspect is the cause of the patient's condition? A. Absence of bile in the small intestine B. Hindered bile flow into the duodenum C. Presence of dissolved bilirubin in urine D. Absence of bile salts in the duodenum

D. Absence of bile salts in the duodenum

A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy? A. Low-grade fever of 100 o F and dehydration B. Abscess in the right upper quadrant of the abdomen C. Multiple obstructions in the cystic and common bile duct D. Activated partial thromboplastin time (aPTT) of 54 seconds

D. Activated partial thromboplastin time (aPTT) of 54 seconds

A patient presents with acute upper quadrant pain radiating to the back that the patient rates as a 10 on a 1 to 10 pain scale. The patient says, "I'm nauseated, and I've vomited several times." The diagnosis is cholecystitis with cholelithiasis. Which collaborative nursing diagnosis does the nurse recognize as the highest priority? A. Impaired skin integrity related to the surgical incision B. Anxiety related to knowledge deficit of diagnostic studies C. Risk for fluid volume deficit related to nausea and vomiting D. Acute pain related to inflammation and blockage of the biliary tract

D. Acute pain related to inflammation and blockage of the biliary tract

A patient reports severe pain in the abdomen to a nurse. The nurse finds the patient's body temperature is 100° F. The laboratory reports show a white blood cell (WBC) count of 13,000/μL, lipase of 180 U/L, and amylase of 150 U/L. What finding does the nurse anticipate? A. Hepatitis B. Cholelithiasis C. Liver cirrhosis D. Acute pancreatitis

D. Acute pancreatitis

A patient whose laboratory report demonstrates elevated serum amylase, triglycerides, and lipase levels as well as hyperglycemia reports severe, piercing pain in the abdomen accompanied by shortness of breath and a red face. What does the nurse suspect the diagnosis to be? A. Cirrhosis B. Cholecystitis C. Pancreatic cancer D. Acute pancreatitis

D. Acute pancreatitis

The nurse suspects that a patient has hepatitis A. Which symptom will the patient most likely report that it developed first? A. Ascites B. Itching C. Jaundice D. Anorexia

D. Anorexia

A patient with a 3-year history of liver cirrhosis is hospitalized for treatment of recently diagnosed esophageal varices. What is the most important information for the nurse to include in the teaching plan for this patient? A. Decrease fluid intake to avoid ascites. B. Eat foods quickly so they do not get cold and cause distress. C. Avoid exercise because it may cause bleeding of the varices. D. Avoid straining during defecation to keep venous pressure low.

D. Avoid straining during defecation to keep venous pressure low.

The nurse teaches a caregiver about postoperative care for a patient who has undergone an open cholecystectomy. Which action by the caregiver may aggravate the patient's condition? A. Encouraging deep-breathing exercises B. Allowing bile to drain from the insertion site C. Ensuring that the room is sufficiently ventilated D. Avoiding the skin around the T-tube insertion site while cleaning

D. Avoiding the skin around the T-tube insertion site while cleaning

What does a nurse anticipate that the primary health care provider will prescribe for a patient with pancreatitis who reports irritability and tingling around the lips? A. Insulin B. Vitamin K C. Cholestyramine D. Calcium gluconate

D. Calcium gluconate

A patient reports severe abdominal pain. A primary health care provider diagnoses it to be chronic pancreatitis secondary to cholecystitis. Which treatment option does the nurse anticipate will be beneficial? A. Cholecystectomy B. Whipple procedure C. Chemoembolization D. Choledochojejunostomy

D. Choledochojejunostomy

The health care provider prescribes lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what? A. Relief of constipation B. Relief of abdominal pain C. Decreased liver enzymes D. Decreased ammonia levels

D. Decreased ammonia levels

During history-taking, a patient tells the nurse, "Gallstones were removed by passing shock waves into my gallbladder." Which procedure is the patient referring to? A. Cholecystojejunostomy B. Pancreaticoduodenectomy C. Balloon sphincteroplasty D. Extracorporeal shock-wave lithotripsy (ESWL)

D. Extracorporeal shock-wave lithotripsy (ESWL)

The nurse cares for a patient with advanced cirrhosis. What indicates that the patient is experiencing a serious complication? A. Urine retention B. Increased blood glucose C. No bowel movement in three days D. Frequent nosebleeds and bruising

D. Frequent nosebleeds and bruising

Assessment findings of a patient include asterixis, hyperventilation, fetor hepaticus, fatigue, a body temperature of 95° F, and continuous lip smacking. Which condition does the nurse suspect? A. Hepatitis B. Liver cirrhosis C. Hepatorenal syndrome D. Hepatic encephalopathy

D. Hepatic encephalopathy

A patient presents with fatigue, nausea, vomiting, and yellowish-colored eyes. A serum bilirubin test and complete urine examination are prescribed. The test results reveal increased serum levels of both conjugated and unconjugated bilirubin and increased levels of bilirubin in the urine. The nurse suspects what diagnosis? A. Acute hepatitis B. Chronic hepatitis C. Hemolytic jaundice D. Hepatocellular jaundice

D. Hepatocellular jaundice

A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication prescription should the nurse question because it is most likely to cause hepatic complications? A. Tramadol B. Hydromorphone C. Oxycodone with aspirin D. Hydrocodone with acetaminophen

D. Hydrocodone with acetaminophen

The nurse is caring for a patient with acute pancreatitis. What laboratory studies should the nurse monitor that demonstrate a change in the pancreas? A. Increased levels of sodium B. Increased levels of glucose C. Increased levels of potassium D. Increased levels of triglycerides

D. Increased levels of triglycerides

When planning care for a patient with cirrhosis who has significant abdominal ascites, the nurse will give highest priority to which nursing diagnosis? A. Impaired skin integrity related to edema, ascites, and pruritus B. Imbalanced nutrition: less than body requirements related to anorexia C. Excess fluid volume related to portal hypertension and hyperaldosteronism D. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

D. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

A nurse is preparing a patient experiencing three to four episodes of vomiting each day for endoscopy. The patient has a nasogastric tube connected to low intermittent gastric suctioning. What nursing action is a priority for this patient? A. Administration of Creon B. Infusion of calcium gluconate C. Administration of dicyclomine D. Infusion of lactated Ringer's solution

D. Infusion of lactated Ringer's solution

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention should the nurse expect to include in the patient's plan of care? A. Immediately start enteral feeding to prevent malnutrition B. Initiate early prophylactic antibiotic therapy to prevent infection C. Administer acetaminophen (Tylenol) every four hours for pain relief D. Insert a nasogastric (NG) tube and maintain nothing by mouth (NPO) status to allow the pancreas to rest

D. Insert a nasogastric (NG) tube and maintain nothing by mouth (NPO) status to allow the pancreas to rest

A patient who underwent a cholecystectomy is now complaining of pain referred to his right shoulder. What is the most probable cause for this pain? Select all that apply. A. Myocardial infarction B. Pericarditis after surgery C. Gallstone left accidentally D. Irritation of the phrenic nerve E. Carbon dioxide that was used in surgery

D. Irritation of the phrenic nerve E. Carbon dioxide that was used in surgery

A patient with cholecystitis receives a prescription for cholestyramine in powdered form. The nurse should provide the patient with what medication instruction? A. Avoid mixing the medication with water. B. Avoid taking the medication with fruit juice. C. Take the medication directly from the container. D. Mix the medication with four to six ounces of milk.

D. Mix the medication with four to six ounces of milk.

A patient reports itching and abdominal pain accompanied with rapid heartbeat. The results of urine and stool samples show clay-colored stools, amber colored urine, and foaming when the urine is shaken. The nurse suspects what diagnosis? A. Chronic pancreatitis B. Chemoembolization C. Hepatoencephalopathy D. Obstruction of bile flow

D. Obstruction of bile flow

The nurse identifies that a patient is at risk for developing cholelithiasis based on the patient's history of what? A. Antibiotic use B. Vasodilator therapy C. Anticholinergic therapy D. Oral contraceptive use

D. Oral contraceptive use

A patient reports severe abdominal pain, nausea, and vomiting. The nurse assesses that the patient has a mass in the upper region of the abdomen. The laboratory reports show the white blood cell (WBC) count as 12,000 cells/μL. What does the nurse anticipate that the patient will be treated for? A. Pseudocyst B. Cullen's sign C. Spider angioma D. Pancreatic abscess

D. Pancreatic abscess

Which condition is associated with the accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates? A. Biliary sludge B. Biliary atresia C. Pancreatic abscess D. Pancreatic pseudocyst

D. Pancreatic pseudocyst

The nurse is caring for a patient who is undergoing radiation therapy for pancreatic cancer. What nursing action is most beneficial for this patient? A. Giving a low-fiber diet B. Ignoring persistent skin irritation C. Increasing dairy products in the diet D. Providing brightly-colored and attractive food

D. Providing brightly-colored and attractive food

The nurse is providing care to a patient with cholecystitis that is experiencing severe nausea and vomiting. The nurse should include what intervention? A. Encouraging exercise B. Assisting with ambulation C. Assisting with repositioning D. Providing oral care every two hours

D. Providing oral care every two hours

A patient admitted to the hospital with cirrhosis of the liver suddenly starts vomiting blood. What is the priority action that the nurse should take in this situation? A. Give propranolol orally. B. Check for signs of cirrhosis. C. Send for endoscopic variceal ligation. D. Stabilize the patient and manage the airway.

D. Stabilize the patient and manage the airway.

A patient with cirrhosis of the liver has ascites and is being prepared for a paracentesis. What instructions should the nurse give the patient? A. The patient should fast overnight. B. The patient should not pass urine until the procedure. C. The patient should not take any fluids before the procedure. D. The patient should void urine immediately before the paracentesis.

D. The patient should void urine immediately before the paracentesis.

The nurse recalls that which surgical instrument is used preoperatively in a patient who will be undergoing an open cholecystectomy? A. Biliary stent B. Laparoscope C. Catheter with wire basket D. Transhepatic biliary catheter

D. Transhepatic biliary catheter

A patient comes to the emergency room with acute abdominal pain after eating a large fast-food meal. The physician takes a history of events while the nurse draws blood to assess for liver function and white blood cell count. What should the nurse tell the patient is the most likely next step in the evaluation? A. Administration of antibiotics B. Insertion of a nasogastric tube C. Transport to the operating room D. Transport to radiology for an ultrasound scan

D. Transport to radiology for an ultrasound scan

A patient with liver cancer is scheduled to receive radiofrequency ablation (RFA) therapy. The nurse knows that this treatment is appropriate for which of these? A. Metastatic liver cancer B. Large tumors over 6 cm in size C. Tumors that are less than 3 cm in size D. Tumors that are less than 5 cm in size

D. Tumors that are less than 5 cm in size