Chapter 44: Liver, Pancreas, and Biliary Tract Problems, Med Surge 3, Exam 1, UTI, Liver, Pancreas, and Biliary Tract Problem

A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. The best response by the nurse is. . .

"A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile."

A patient with cirrhosis asks that nurse about the possibility of a liver transplant. The best response by the nurse is. . .

"Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?"

A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse?

"Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?"

The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral edema related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective?

"Herbs and other spices should be used to season my foods instead of salt." Rationale: A low-sodium diet is indicated for the patient with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided.

The nurse identifies a need for further teaching when the patient with hepatitis B makes which statement?

"I must avoid all physical contact with my family until the jaundice is gone."

The nurse identifies a need for further teaching when the patient with hepatitis B states. . .

"I must avoid all physical contact with my family until the jaundice is gone."

The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis makes which statement

"I shouldn't eat any salty foods or foods wit high amounts of sodium."

A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse?

"Interferon combined with lamivudine (Epivir) will decrease viral load and prevent complications"

The family member of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. The best response by the nurse is. . .

"Those who have had household or close contact with the patient should receive immune globulin."

A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it

AV fistulas are much less likely to clot than grafts, although it takes longer for them to mature to the point where they can be used for dialysis. The choice of an AV fistula or a graft does not have an impact on needle size or patient mobility.

A patient with an obstruction of the common bile duct has clay-colored fatty stools, among other manifestations. What is the pathophysiologic change that causes this clinical manifestation

Absence of bile salts in the intestine and duodenum, preventing fat emulsion and digestion

In discussing long-term management with the patient with alcoholic cirrhosis, what should the nurse advise the patient?

Abstinence from alcohol is the most important factor in improvement of the patient's condition

In discussing long term management with the patient with alcoholic cirrhosis, the nurse advises the patient that. . .

Abstinence from alcohol is the most important factor in improvement of the patients condition.

A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy?

Activated partial thromboplastin time (aPTT) of 54 seconds Rationale: An aPTT of 54 seconds is above normal and indicates insufficient clotting ability. If the patient had surgery, significant bleeding complications postoperatively are very likely.

What causes the systemic effects of viral hepatitis?

Activation of the complement system by antigen-antibody complexes

The systemic effects of viral hepatitis are caused primarily by. . .

Activation of the complement system of antigen-antibody complexes.

Postoperatively, a patient with an incisional cholecystectomy has a nursing diagnosis of ineffective breathing pattern related to splinted respirations secondary to a high abdominal incision. Which action should the nurse take first?

Administer the prescribed analgesic

Excessive fluid continues to be reabsorbed from the kidney because of the altered kidney perfusion and because ______ is not metabolized by the impaired liver.

Aldosterone

During the incubation period of viral hepatitis, what should the nurse expect the patient to report?

Anorexia and right upper quadrant discomfort

During the incubation period of viral hepatitis, the nurse would expect the patient to report. . .

Anorexia and right upper quadrant discomfort.

Which conditions contribute to the formation of abdominal ascites?

Blood flow through the portal system is obstructed, which causes portal hypertension

The nurse gives discharge instructions to the family of a patient diagnosed with hepatic encephalopathy. The nurse determines further teaching is necessary if the family makes which of the following statements? a) We should contact the physician if Dad is restless at night." b) "Cephulac will cause Dad to have 2-3 stools per day." c) "Dad should eat meat at every meal." d) "Cephulac may cause bloating and cramps.

C. "Dad should eat meat at every meal." low-protein, high-calorie diet for clients with hepatic encephalopathy

Which information will be most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?

Calculated glomerular filtration rate (GFR) GFR is the preferred method for evaluating kidney function.

A patient who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV?

Cardiac Rhythm The calcium gluconate helps prevent dysrhythmias that might be caused by the hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.

What are the s/s of UTI?

Changes in urine-----may contain visible blood, sediment, appear cloudy, foul odor Flank pain, chills, and fever indicate infection of upper tract----pyelonephritis

After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which action should the nurse take first?

Check the chart for the most recent blood potassium level. The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider.

When caring for a patient with a left arm arteriovenous fistula, which action will the nurse include in the plan of care to maintain the patency of the fistula?

Check the fistula site for a bruit and thrill. The presence of a thrill and bruit indicates adequate blood flow through the fistula.

A big risk factor associated with cancer of the pancreas is. . .

Cigarette smoking

What is a big risk factor associated with cancer of the pancreas?

Cigarette smoking

What is a risk factor associated with cancer of the pancreas?

Cigarette smoking

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?

Control abdominal pain Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. NPO status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis.

The nurse cares for a client with a Sengstaken-Blakemore tube to treat bleeding esophageal varices. The client suddenly develops respiratory distress. Which action should the nurse take FIRST?

Cut the balloon port on the Sengstaken-Blakemore tube keep a pair of scissors at bedside; cutting the port will deflate the balloon and allow the nurse to remove the tube

How do we treat UTIs?

Antibiotics--selected on empiric therapy(based on research, knows it works) or results of sensitivity testing (culture and sensitivity which pathogen, what antibiotic will kill it

The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe?

Assist the patient to the bathroom

What are symptoms of UTI in older adults?

Atypical presentation, symptoms often absent, nonlocalized abdominal discomfort, s/s like dysuria Cognitive impairment--confused, not themselves, less likely to have a fever r/t decreased immune

How do we educate the UTI patient?

Avoid potential bladder irritants----caffeine, alcohol, citrus juices, chocolate, high spiced foods Take full course of antibiotic--dont stop in the middle, take it all Drug therapy & SE---2nd or reduced drug may be ordered after initial course in susceptible patients

A new order for IV gentamicin (Garamycin) 60 mg BID is received for a patient with diabetes who has pneumonia. When evaluating for adverse effects of the medication, the nurse will plan to monitor the patient's ____________?

BUN and creatinine When a patient at risk for chronic kidney disease (CKD) receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels.

When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements?

Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat-soluble and thus would need to be supplemented in a patient with biliary obstruction.

The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided

-Avoid nicotine - Eat bland foods. -Observe stools for steatorrhea

The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (name 3 things)

1. Avoid nicotine 2. Eat bland foods. 3. Observe stools for steatorrhea

The nurse is instructing a patient with chronic pancreatitis on 3 measures to prevent further attacks. What information should be provided?

1. Avoid nicotine, 2. eat bland foods, 3. observe stools for steatorrhea

Risk factors associated with cholelithiasis:

1. Family history of gallbladder disease 2. Multiparous female 3. Obesity 4. Age over 40 5. Use of estrogen or oral contraceptives

Who is more prone to UTI's

1. Immune suppressed 2. DM pt's 3.3rd world countries 4. multiple antibiotic courses

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

1. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. 2. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. 3. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.

The patient is an older woman with cirrhosis who also has anemia. What 3 pathophysiologic changes may contribute to this patient's anemia

1. Vit B deficiencies 2. Vascular congestion of spleen 3. Decreased prothrombin production

A patient was diagnosed with nonalcolic fatty liver disease. What treatment measures should the nurse plan to teach the patient about?

1. Weight loss 2. diabetes 3. dietary management of hyperlipidemia

5 characteristics most commonly associated with choleithiasis

1. obesity 2. age over 40 3. multiparous female 4. family history of gallbladder disease 5. use of estrogen or oral contraceptives

What is a UTI, who is affected, causes?

2nd most common bacterial disease overall E. coli most common pathogen #1 in women sexually active disproportionately affected elderly patients/catheter (prone to UTI) gram negative bacteriaemia fungal/parasitic infections can cause UTIs

A patient complains of leg cramps during hemodialysis. The nurse should first

Infuse a bolus of normal saline. Muscle cramps during dialysis are caused by rapid removal of sodium and water. Treatment includes infusion of normal saline. The other actions do not address the reason for the cramps.

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care?

Insert an NG and maintain NPO status to allow pancreas to rest Rationale: Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal.

What manifestation in the patient does the nurse recognize as an early sign of hepatic encephalopathy?

Is irritable and lethargic

The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. The nurse explains to the patient that this test. . .

Is noninvasive and is a very reliable method of detecting gallstones

When caring for a patient with autoimmune hepatitis, the nurse recognizes that, unlike viral hepatitis, the patient. . .

Is treated with corticosteroids or other immunosuppressant agents.

When caring for a patient with autoimmune hepatitis, the nurse understands that what in this patient is different from the patient who has viral hepatitis?

Is treated with corticosteroids or other immunosuppressive agents

The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse explain to the patient about this test?

It is noninvasive and is a very reliable method of detecting gallstones

To treat a cirrhotic patient with hepatic encephalopathy, lactulose (Cephulac), rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient's family wants to know why the lactulose is ordered. What is the best explanation the nurse can give to the patient's family?

It traps ammonia and eliminates it in the feces

To treat a cirrhotic patient with hepatic encephalopathy, lactulose (Cephulac), rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient's family wants to know why the laxative is ordered. What is the best explanation the nurse can give to the patient's family?

It traps ammonia and eliminates it in the feces

The nurse is caring for a patient who had kidney transplantation several years ago. Which assessment finding may indicate that the patient is experiencing adverse effects to the prescribed corticosteroid?

Joint Pain Aseptic necrosis of the weight-bearing joints can occur when patients take corticosteroids over a prolonged period. Increased creatinine level, orthostatic dizziness, and tachycardia are not caused by corticosteroid use.

What must the nurse do to care for a Ttube ina patient following a cholecystectomy?

Keep the tube supported and free of kinks.

The surgical treatment of choice for the patient with symptomatic gallbladder disease is a

Laparoscopic cholecystectomy Rationale: Laparoscopic cholecystectomy is the surgical treatment of choice for patients with symptomatic cholelithiasis.

The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit?

Left upper abdominal pain Rationale: Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis.

Fluid moves into the abdominal cavity, producing ascites because of decreased serum oncotic colloidal pressure. The decreased serum oncotic pressure is caused by ______

Decreased albumin production

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what?

Decreased ammonia levels Rationale: Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract.

Which manifestations may be seen in the patient with cirrhosis related to esophageal varices?

Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension

What are 3 signs of UPPER tract infection?

Flank pain, chills, fever

What is drug therapy for UTI (antibiotics)

Fluoroquinolones--- Example: Ciprofloxacin(Cipro), treat complicated UTI's Drink 1-2 quarts or 1500-2000mL of fluid/day to reduce risk of crystalluria (happens with Cipro)

The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder disease. Which statement by the patient to the nurse indicates she understands the instructions?

For treatment of pruritus, cholestyramine may provide relief. This is a resin that binds bile salts in the intestine, increasing their excretion in the feces. Cholestyramine is in powder form and should be mixed with milk or juice before oral administration.

What test will be done before prescribing treatment for the patient eith positive testing for HCV?

HCV genotyping

Following laparoscopic cholecystectomy, the nurse would expect the patient to. . .

Have four small abdominal incisions covered with small dressings

Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care?

Have up to four small abdominal incisions covered with small abdominal incisions covered with small dressings

Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increase the risk of the chronic carrier for hepatocellular cancer?

Hep B

The patient returned from a 6-week mission trip to Somalia with complaints of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted?

Hep E

A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a peritoneovenous shunt. As a result of this procedure, the nurse would expect the patient to experience. . .

Improved hemodynamic function and renal perfusion

A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a portacaval shunt. As a result of of this procedure, what should the nurse expect the patient to experience?

Improved hemodynamic function and renal perfusion

Combined with clinical manifestations, what is the laboratory finding that is most commonly usedd to diagnose acute pancreatitis?

Increase serum amylase

Combined with clinical manifestations, the lab findings that is most commonly used to diagnose acute pancreatitis is. . .

Increased serum amylase

The patient asks why the serologic test of HBV DNA quantitation is being done. What is the best rationale for the nurse to explain the test to the patients?

Indicates viral replication and effectiveness of therapy for chronic HBV

A patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and an elevated blood urea nitrogen (BUN) and creatinine. Which of these prescribed therapies should the nurse implement first? a. Obtain renal ultrasound. b. Insert retention catheter. c. Infuse normal saline at 50 mL/hour. d. Draw blood for complete blood count.

b. Insert retention catheter. The patient's elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient.

Which patient information will the nurse plan to obtain in order to determine the effectiveness of the prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance

b. Phosphate level Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD.

When caring for a dehydrated patient with acute kidney injury who is oliguric, anemic, and hyperkalemic, which of the following prescribed actions should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit). d. Give sodium polystyrene sulfonate (Kayexalate).

b. Place the patient on a cardiac monitor. Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm.

The nurse obtains a history from a client suspected of having cirrhosis. Which statement, if made by the client to the nurse, should the nurse recognize as MOST directly related to a client's development of cirrhosis? a) "For the past several weeks I have not slept for more than five hours a night." b) "Since my spouse left me five years ago, I have been eating terribly." c) "I have been drinking about a fifth of vodka a day for the last few months." d) "My spouse was a heavy smoker, and I am concerned about second-hand smoke."

c) "I have been drinking about a fifth of vodka a day for the past few months." alcohol has a toxic effect on the liver, which causes liver inflammation; s/s include N/V, anorexia, weight loss, flatulence, fatigue, headache, ascites, jaundice, and spider angiomas

A patient with chronic kidney disease (CKD) brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required?

Magnesium is excreted by the kidneys, and patients with CKD should not use over-the-counter products containing magnesium. The other medications are appropriate for a patient with CKD.

During the treatment of the patient with bleeding esophageal varices, it is most important that the nurse. . .

Maintain the patient's airway and prevent aspiration of blood

During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do?

Maintain the patient's airway and prevent aspiration of blood

What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis?

Malabsorption and DM

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?

Milk thistle may affect liver enzymes and thus alter drug metabolism Rationale: There is good scientific evidence that there is no real benefit from using milk thistle to protect the liver cells from toxic damage in the treatment of cirrhosis. Milk thistle does affect liver enzymes and thus could alter drug metabolism.

The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant?

Monitor closely for infection because of the immunosuppressive medication

Management of the patient with acute pancreatitis includes. . .

NG suction to prevent gastric contents from entering the duodenum

What treatment measure is used in the management of the patient with acute pancreatitis?

NG suction to prevent gastric contents from entering the duoenum

The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain by suppressing pancreatic secretions is the use of:

NPO status Rationale: Pain from acute pancreatitis is aggravated by eating; NPO status will help to alleviate the pain by decreasing pancreatic secretions

What treatment for acute cholecystitis will prevent further stimulation of the gallbladder

NPO with NG suction

What treatment for acute cholecystitiswill prevent further stimulation of the gallbladder

NPO with NG suction

What about nosocomial urinary tract infection?

Nosocomial or health care--associated infections (HAIs) 31% are UTI's Catheter-acquired UTI's (CAUTI's)---most common nosocomial infection

One of the most challenging nursing interventions to promote healing in the patient with viral Hepatitis is . . .

Providing adequate nutritional intake

What is one of the most challenging interventions to promote healing in the patient with viral hepatitis?

Providing adequate nutritional intake

The nurse understands which of these factors is the MOST likely source of hepatitis D? a) Eating infected shellfish b) Overly exerting oneself c) Practicing poor hygiene d) Receiving a blood transfusion

Receiving a blood transfusion hepatitis D co-infects with hepatitis B; spread by contact with blood and bodily fluids

A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include

Recommending a heart-healthy diet

After cholecystectomy, a patient is returned to the unit with a nasogastric tube connected to low intermittent suction, an IV of D5W, a T-tube in place and a Penrose drain. The nurse understands that the purpose of the Penrose drain is

Remove accumulated bile and blood after surgery duct must be allowed to drain; bile would otherwise drain into surrounding tissue, be very caustic, and cause problems for the patient

During discharge instructions for a patient following a laparoscopic cholecystectomy, the nursing advises the patient to. . .

Report and bile colored or purulent drainage from the incisions.

During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in the teaching?

Report any bile-colored or purulent drainage from the incisions.

A patient id hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge?

Supportive care that is appropriate for all patients with severe liver damage is indicated

Serologic findings in viral hepatitis include both the presence of viral antigens and antibodies produced in response to the viruses. What laboratory result indicates that the nurse is immune to HBV after vaccination?

Surface antibody Anti-HBs

During hemodialysis, a patient complains of nausea and dizziness. Which action should the nurse take first? a. Slow down the rate of dialysis. b. Obtain blood to check the blood urea nitrogen (BUN) level. c. Check the patient's blood pressure. d. Give prescribed PRN antiemetic drugs.

c. Check the patient's blood pressure. The patient's complaints of nausea and dizziness suggest hypotension, so the initial action should be to check the BP. The other actions also may be appropriate, based on the blood pressure obtained.

Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse? a. The blood glucose is 144 mg/dL. b. The patient's blood pressure is 150/92. c. There is a nontender lump in the axilla. d. The patient has a round, moonlike face.

c. There is a nontender lump in the axilla. A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of chronic immunosuppressive therapy.

Which information about a patient who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration will be most important for the nurse to report to the health care provider? a. The blood urea nitrogen (BUN) level is 67 mg/dL. b. The creatinine level is 3.0 mg/dL. c. Urine output over an 8-hour period is 2500 mL. d. The glomerular filtration rate is <30 mL/min/1.73m2.

c. Urine output over an 8-hour period is 2500 mL. The high urine output indicates a need to increase fluid intake to prevent hypovolemia. The other information is typical of AKI and will not require a change in therapy

A patient withAKI and severe heart failure develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet the goal of a. replacing fluid volume. b. preventing hypertension. c. maintaining cardiac output. d. diluting nephrotoxic substances.

c. maintaining cardiac output. The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover.

Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess the a. blood urea nitrogen (BUN) and creatinine. b. blood glucose level. c. patient's bowel sounds. d. level of consciousness (LOC).

c. patient's bowel sounds. Sodium polystyrene sulfonate (Kayexalate) should not be given to a patient with a paralytic ileus (as indicated by absent bowel sounds) because bowel necrosis can occur.

A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for a. vasodilation. b. poor skin turgor. c. bounding pulses. d. rapid respirations.

d. rapid respirations. Rationale: Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the lungs try to regulate carbon dioxide.

The patient with chronic pancreatitis is more likely than the patient with acute pancreatitis to. . .

have malabsorption and diabetes mellitus

The nurse recognizes early signs of hepatic encephalopathy in the patient who. . .

is irritable and lethargic

To care for a t-tube in a patient following a cholecystectomy, the nurse. . .

keeps the tube supported and free of kinks

The nursing management of the patient with cholecystitis associated is based on the knowledge that __________?

laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic

The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that a lack of clotting factors promotes the collection of blood in the abdominal cavity

portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space Rationale: Ascites is the accumulation of serous fluid in the peritoneal or abdominal cavity and is a common manifestation of cirrhosis.

A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that

pruritus is a common problem with jaundice in this phase Rationale: The acute phase of jaundice may be icteric or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.

A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the information that a Whipple procedure involves _________________?

removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum

Teaching in relation to home management after a laparoscopic cholecystectomy should include

reporting any bile-colored drainage or pus from any incision Rationale: The following discharge instructions are taught to the patient and caregiver after a laparoscopic cholecystectomy:

What is the TX for complicated UTI's

requires long-term treatment 7-14 days

Before administration of calcium carbonate (Caltrate) to a patient with chronic kidney disease (CKD), the nurse should check the laboratory value for

serum phosphate. If serum phosphate is elevated, the calcium and phosphate can cause soft tissue calcification. The calcium carbonate should not be given until the phosphate level is lowered.

What is the TX for uncomplicated cystitis?

short-term course 1-3 days

A sexual contact of a patient with hepatitis B is given HBIg. The nurse explains to the contact the purpose of the medication is to

temporarily increase the person's resistance to hepatitis an injection of pooled human gamma globulin is an example of passive immunity; there is no guarantee that he won't develop hepatitis

A patient with acute hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to__________________?

use a condom during sexual intercourse Rationale: Hepatitis B virus may be transmitted by mucosal exposure to infected blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

What action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD?

The patient cleans the catheter while taking a bath every day. Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side.

Does upper or lower tracts have more systemic symptoms?

Upper has more Lower doesn't have as many systemic, but lots of discomforts

Drug therapy for UTI? (urinary analgesic)

Urinary analgesis, helps with s/s of UTI but doesn't kill pathogen Pyridium---OTC, used in combo with antibiotics, provides soothing effect on urinary tract mucosa, helps with burning, dysuria, post-dribbling, Stains urine reddish orange (sometimes mistaken for blood, stains underwear)

Which parameter will be most important for the nurse to consider when titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation?

Urine Output Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour.

The occurrence of acute liver failure is most common in which situation?

Use of acetaminophen with alcohol abuse

What does a culture sensitivity test show?

What kind of bacteria is present, and what medication can treat it.

When the nurse is taking a history for a patient who is a possible candidate for a kidney transplant, which information about the patient indicates that the patient is not an appropriate candidate for transplantation? a. The patient has metastatic lung cancer. b. The patient has poorly controlled type 1 diabetes. c. The patient has a history of chronic hepatitis C infection. d. The patient is infected with the human immunodeficiency virus.

a. The patient has metastatic lung cancer. Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant.

How do you minimize discomfort for the patient with UTI?

application of local heat to suprapubic or lower back

The nurse in the outpatient clinic is counseling a client with a diagnosis of cholecystitis. The nurse determines teaching is successful if the client makes which of the following statements? a) "I really like a lot of cream in my oatmeal." b) "We eat a lot of broiled fish and chicken." c) "I can't wait to eat the chocolate my children gave me." d) "My favorite dish is broccoli with cheese and sauce."

b) "We eat a lot of broiled fish and chicken." patients with cholecystitis should eat foods high in protein and low in fat, such as broiled lean meats; cooked fruits, non-gas forming veggies, and bread.

The nurse instructs a client about appropriate foods for a high-protein diet. The nurse determines teaching is effective if the client chooses which menu? a) Chef salad, crackers, and iced tea b) Broiled fish, cream of tomato soup topped with grated cheese, and custard c) Peanut butter and jelly sandwich, chips, and fruit drink d) Turkey sandwich with lettuce and tomato, potato salad, and milk

b) Broiled fish, cream of tomato soup topped with grated cheese, and custard all foods contain protein; increase protein by adding skim milk to soup, add grated cheese to foods, use peanut butter as spread on fruits and veggies, use yogurt as topping for fruit and cake

The nurse cares for a client diagnosed with cholelithiasis. It is MOST important to instruct the client to avoid which of the following foods? SELECT ALL THAT APPLY a) Apples b) Cabbage c) Lettuce d) Cheese e) Chocolate f) Carrots

b) Cabbage d) Cheese e) Chocolate Rational: avoid gas-forming vegetables such as onions, broccoli, radishes, beans, foods high in cholesterol/fat, egg yolks, avocado

Which symptoms of liver disease should the nurse expect to see in a client with Laënnec 's cirrhosis? a) Cloudy urine b) Dark urine c) Orange-colored stools d) Tarry stools

b) Dark urine normally bilirubin is not excreted in urine; urine with abnormal bilirubin is mahogany-colored and has yellow foam when shaken; clients with cirrhosis may have clay-colored stools due to decreased fecal urobilinogen

The nurse identifies which diet BEST meets the nutritional needs of a client diagnosed with cirrhosis? a) High in calories plus vitamin supplements b) High in protein and high in carbohydrates c) High in calcium and low in fat d) High in iron and low in salt

b) High in protein and high in carbohydrates since many alcoholics are malnourished, a high-protein diet is important

The spouse of a client with hepatitis B is given hepatitis B immune globulin (HBIg). The nurse understands this offers which type of protection?

Passive acquired

What are symptoms of UTI?

Patients with significant bacteriuria---may have no symptoms, nonspecific symptoms such as fatigue or anorexia Long term catheter? no symptoms, body gets used to organism living there, and Doc won't treat unless the pt. becomes symptomatic

The retained fluid has low oncotic colloidal pressure, and it escapes into the interstitial spaces, causing _________

Peripheral edema

In a patient with acute kidney injury (AKI) who requires hemodialysis, a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which intervention will be included in the plan of care?

Place the patient on bed rest The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein.

A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in the patient's plan of care.

Position the patient on the side with the head of the bed elevated 45 degrees for pain relief

A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of pancreas and peritoneal irritation. In addition to effective use of analgesics, the nurse should. . .

Position the patient on the side with the head of the bed elevated 45 degrees for pain relief.

A patient with hypertension and stage 2 chronic kidney disease (CKD) is receiving captopril (Capoten). Before administration of the medication, the nurse will check the patient's ___________________?

Potassium Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia.

The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What diagnosis should the nurse expect for this patient?

Primary sclerosing cholangitis

Acalulous cholecystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this condition?

-Fasting -Parenteral nutrition -Prolonged immobility

The patient being treated with diuretics for ascites from cirrhosis must be monitors for?

-Hypokalemia -Renal function

Of the following characteristics, identify those that are most commonly associated with choleithiasis

-obesity -age over 40 -multiparous female -family history of gallbladder disease -use of estrogen or oral contraceptives

The nurse cares for a patient after a traditional cholecystectomy. The nurse should contact the physician if which of the following is observed?

800 cc bloody drainage the first day postop this amount of drainage after a cholecystectomy would indicate hemorrhage; 50 cc is an appropriate amount of drainage

A patient with advanced cirrhosis has a nursing diagnosis of imbalanced nutrition- less than body requirement related to anorexia and inadequate food intake. What would be an appropriate midday snack for the patient?

A fresh tomato sandwich with salt-free butter

A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse?

A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile

In a radical whipple procedure for treatment of cancer of the pancreas, what anatomic structure is completely resected that will affect the patient's nutritional status?

Duodenum adjoining the pancreas

Nursing interventions for UTI---Acute interventions?

Ensure adequate fluid intake---need to drink to flush out bacteria Patient may think will worsen condition due to discomfort Dilutes urine, making bladder less irritable Flushes out bacteria before they can colonize

How often should a person void to prevent a UTI?

Every 3-4 hours

NCLEX review question 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?

Hepatic structure ultrasound, CT, and MRI are used to screen and diagnose liver cancer.

In planning care for a patient with metastatic liver cancer, the nurse should include interventions that include ____?

Nursing intervention for a patient with liver cancer focuses on keeping the patient as comfortable as possible. The prognosis for patients with liver cancer is poor. The cancer grows rapidly, and death may occur within 4 to 7 months as a result of hepatic encephalopathy or massive blood loss from gastrointestinal (GI) bleeding.

The patient has a diagnosis of a biliary obstruction form gallstones. What type of jaundice is the patient experiencing and what serum bilirubin results would be expected?

Obstructive jaundice with elevated unconjugated and conjugated bilirubin

Immediately following a liver biopsy, the nurse should position the client in which position?

On the right side after a liver biopsy, it is important to prevent leakage of fluid or hemorrhage from occurring; because of this, the idea position is to lie directly ON the liver with the ribs pushing on the liver; place a pillow under costal margin; determine prothrombin time, PTT, and platelet count prior to procedure; report abnormal findings to health care provider

When a patient who has had progressive chronic kidney disease (CKD) for several years is started on hemodialysis, which information about diet will the nurse include in patient teaching?

Once the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath.

Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis?

Pancreatic abscess

The nurse understands which of the following is the principal reason for the use of enzyme inhibitors (Diamox) in a patient with pancreatitis?

Pancreatic enzymes escape into interstitial tissue Diamox helps inactivate these enzymes to help minimize the damage they would cause to normal tissue

The nurse cares for a patient after a traditional cholecystectomy. It is MOST important for the nurse to position the patient in which of the following positions?

Semi-Fowler's semi-Fowler's is optimal for the patient because it will allow her to take the necessary deep breaths that are important to prevent pneumonia after surgery; supine with bed flat is a position difficult to breath in and would place tension on the suture line

When assessing a patient with acute pancreatitis, the nurse would expect to find. . .

Severe midepigastric or LUQ pain

When assessing a patient with acute pancreatitis, the nurse would expect to find

Severe midepigastric or left upper quadrant pain

The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which information should be reported immediately to the health care provider? a. The patient has an outflow volume of 1800 mL. b. The patient's peritoneal effluent appears cloudy. c. The patient has abdominal pain during the inflow phase. d. The patient complains of feeling bloated after the inflow.

b. The patient's peritoneal effluent appears cloudy. Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started.

Which of the following information obtained by the nurse who is caring for a patient with end-stage renal disease (ESRD) indicates the nurse should consult with the health care provider before giving the prescribed epoetin alfa (Procrit)? a. Creatinine 1.2 mg/dL b. Oxygen saturation 89% c. Hemoglobin level 13 g/dL d. Blood pressure 98/56 mm Hg

c. Hemoglobin level 13 g/dL High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack, heart failure, stroke) when EPO is administered to a target hemoglobin of >12 g/dL. Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose.

A patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous pyelogram (IVP). Which of these orders for the patient will the nurse question? a. NPO for 6 hours before IVP procedure b. Normal saline 500 mL IV before procedure c. Ibuprofen (Advil) 400 mg PO PRN for pain d. Dulcolax suppository 4 hours before IVP procedure

c. Ibuprofen (Advil) 400 mg PO PRN for pain The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other nephrotoxic medications such as the NSAIDs should be avoided.