Chapter 46 CARE OF THE PATIENT WITH A GALLBLADDER, LIVER, BILIARY TRACK, OR EXOCRINE PANCREATIC DISORDER

Which medical interventions and management systems control the bleeding of esophageal varices? (Select all that apply.) a. Transfusions b. Sengstaken-Blakemore tube c. Band ligation d. Cryotherapy e. Portacaval shunt f. Large doses of vitamin B12

ANS: B, C, E Band ligation, insertion of the S/B tube, and various shunting surgeries are helpful in stopping the hemorrhage. Transfusions and water-soluble vitamins are not beneficial.

What is the challenge in encouraging coughing and deep breathing for a postoperative patient who had an open cholecystectomy? a. High placement of incision b. Excessive nausea c. Weakened abdominal muscles d. Poor oxygenation

ANS: A The high placement of the incision of the cholecystectomy makes the patient reluctant to cough. Splinting the incision is beneficial.

What is the most common procedure for the removal of the gallbladder? a. Laparoscopic cholecystectomy b. Cholangiography c. Open cholecystectomy d. Choledochostomy

ANS: A The most recently developed operative procedure, which is now the most common treatment for cholecystitis and cholelithiasis, is done by way of endoscopy. It is called laparoscopic cholecystectomy and uses laser cautery to remove the gallbladder.

A family member of a patient asks the nurse about the protein-restricted diet ordered because of advanced liver disease with hepatic encephalopathy. What statement by the nurse would best explain the purpose of the diet? a. "The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system." b. "The liver heals better with a high-carbohydrate diet rather than with a diet high in protein." c. "Most people have too much protein in their diets. The amount in this diet is better for liver healing." d. "Because of portal hypertension, the blood flows around the liver, and ammonia made from protein collects in the brain, causing hallucinations."

ANS: A The patient with hepatic encephalopathy is on a very low-protein to no-protein diet. The goal of management of hepatic encephalopathy is the reduction of ammonia formation in the intestines.

The nurse is talking with a patient who has been experiencing nausea and vomiting. The patient indicates an interest in using alternative therapies for the condition. Which product may aid in nausea management? a. Ginger b. Ginseng c. Chamomile d. Soy

ANS: A Ginger has been used for centuries in Asia to combat nausea and vomiting, motion sickness, and dyspepsia. It is available candied in capsules, fluid extract, and tablets, and tincture or as fresh ginger root that can be grated and used to make tea. Ginger may decrease the action of histamine (H2) receptor antagonists and proton pump inhibitors and may increase absorption of medications taken orally. Ginger may decrease the effect of antidiabetic medications. It should not be used during pregnancy or lactation.

When assessing a patient's bowel sounds, nurse auscultates loud bowel sounds in each quadrant every 3 seconds. The nurse understands that these findings could indicate that the patient is experiencing which condition? a. Diarrhea b. Paralytic ileus c. Vomiting d. Constipation

ANS: A Loud, rapid bowel sounds are indicative of hypermobility, which could resulting diarrhea. Absent bowel sounds are associated with paralytic ileus. Normal bowel sounds present as soft gurgles and clicks every5 to 15 seconds. Hypoactive bowel sounds indicate decreased motility and could indicate that the patient is constipated

Dietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which foods should be avoided? (Select all that apply.) a. Peanut butter b. Grilled chicken c. Rice and pasta d. Bananas, apples, oranges e. Whole milk f. Glazed chocolate doughnuts

ANS: A, E, F Peanut butter, nuts, chocolate, whole milk, fried foods, and cream and other fatty foods should be avoided

Which factors are most commonly associated with pancreatitis? a. Coronary artery disease b. Alcoholism and biliary tract disease c. Cirrhosis d. History of myocardial infarction

ANS: B Alcoholism and biliary tract disease are the two factors most commonly associated with pancreatitis.

The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient waves to the nurse as she enters the room. How should the nurse interpret this? a. As an attempt to get the nurse's attention b. As asterixis c. As an indication of respiratory obstruction from varices d. As spasticity

ANS: B Asterixis is the "flapping tremor" seen as the patient deteriorates into ammonia intoxication or hepatic encephalopathy

A patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. Which of the following is the best response? a. "Diagnostic tests depend on you not eating anything." b. "The pancreas is stimulated whenever you eat or drink and causes pain." c. "Eating causes the need for a bowel movement, which excretes your medication too rapidly." d. "Resting your GI tract will cure your pancreatitis."

ANS: B Food and fluids are withheld to avoid stimulating pancreatic activity, and IV fluids are administered

A male patient states that he returned from a 2-week camping trip a few days ago. He complains of nausea and anorexia, and dark urine. What additional information would assist in diagnosing hepatitis A? a. Exposure to blood b. Recent ingestion of raw fish c. History of intravenous drug use d. Multiple sex partners

ANS: B Hepatitis A spreads by direct contact through the oral-fecal route, usually by food and water contaminated with feces

When caring for an extremely jaundiced patient with cirrhosis, what should the nurse include provisions for in the plan of care? a. Encouraging consumption of a high-fat diet b. Skin care to relieve pruritus c. Offering foods rich in fat-soluble vitamins d. Meticulous foot care

ANS: B Jaundice causes pruritus and can lead to skin lesions and pressure injury.

Which nursing intervention should be completed immediately after the physician has performed a needle liver biopsy? a. Assisting to ambulate for the bathroom b. Keeping the patient on the right side for a minimum of 2 hours c. Taking vital signs every 4 hours d. Keeping the patient on the left side for a minimum of 4 hours

ANS: B Keep the patient lying on the right side with a rolled towel against the puncture site for minimum of 2 hours to splint the puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak. Vital signs are taken every 15 minutes for 30 minutes, then every 30 minutes for 2 hours.

The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5 to 5 g/dL. Based on these findings, what would the nurse expect the patient to exhibit? a. Jaundice b. Edema c. Copious urine output d. Pallor

ANS: B Low serum albumin levels result also from excessive loss of albumin into urine or into third-space volumes, causing ascites or edema.

Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. What should the nurse suspect? a. Peritonitis b. Pneumothorax c. Hemorrhage of the liver d. Pleural effusion

ANS: B Pneumothorax is a possible complication of paracentesis. The patient's head of the bed should be raised slightly but kept on the right side. Oxygen should be administered and the assessment reported to the charge nurse and documented.

The nurse clarifies that deterioration progresses through stages before presenting with liver disease. The first stage is destruction. What is the last stage? a. Liver disease b. Inflammation c. Hepatic insufficiency d. Destruction e. Fibrotic regeneration

ANS: A Liver deterioration follows a pattern of stages: destruction, inflammation, fibrotic regeneration; hepatic insufficiency then presents as liver disease.

The patient's cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of the complication of: a. esophageal varices. b. diverticulosis. c. Crohn disease. d. esophageal reflux (GERD).

ANS: A Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension

What should the nurse avoid contamination from to prevent the transmission of hepatitis A? a. Food or water b. Blood transfusion c. Needles d. Sexual contact

ANS: A Hepatitis A virus is transmitted when a person puts something in his or her mouth that is contaminated with fecal material (called fecal-oral transmission). Teach patients the importance of good hand washing after the bathroom or changing a diaper, as well as proper food preparation, to prevent the spread of HAV.

What is the most appropriate method used by high-risk health workers to prevent hepatitis B? a. Hepatitis B vaccine b. Diligent hand washing c. Wearing protective gear d. Hb immune globulin injections

ANS: A The best preventive measure against the contraction of hepatitis B is HBV vaccine.

The tumor marker that is elevated in patients with pancreatic cancer is ______.

ANS: CA19-9 The tumor marker CA19-9 is elevated in the presence of pancreatic cancer.

___________ is a condition characterized by yellowing of the sclera and the skin.

ANS: Jaundice Jaundice is the discoloration of body tissues caused by abnormally high blood levels of bilirubin.

Hepatitis D is usually seen as a coinfection with __________.

ANS: hepatitis B Hepatitis D is usually seen as a coinfection with hepatitis B.

The disease that is on the increase because of the growing obesity population and is associated with coronary artery disease and use of corticosteroids is _______________.

ANS: nonalcoholic fatty liver disease (NAFLD) nonalcoholic fatty liver disease NAFLD NAFLD is a disease that is on the rise due to the increasing population of obese persons. The disease is also associated with CAD and the use of corticosteroids.

A ___________ occurs when the body encapsulates the autodigestive debris in the pancreatic tissue, frequently becoming an abscess.

ANS: pseudocyst A pseudocyst occurs when the body encapsulates the autodigestive debris in the pancreatic tissue

The 100 lb patient who has been exposed to hepatitis A is to receive an injection of immune serum globulin. What should the dose (.02 mL/kg) be? a. 0.9 mL b. 1.4 mL c. 1.6 mL d. 1.8 mL

ANS: A 100 lb/2.2 = 45.4. 45.4 ´ 0.02 = 0.90.

Which patient statement indicates that the patient requires additional teaching about an endoscopic retrograde cholangiopancreatography? a. "Right after the test, I want breakfast with black coffee." b. "The instrument will be put down my throat." c. "I haven't had anything to eat or drink since 9 p.m. last night." d. "My doctor said I could have medicine to relax me before the test."

ANS: A After the procedure, keep the patient NPO until the gag reflex returns.

The nurse is caring for a patient who is complaining of postoperative gas pain. What intervention should nurse implement? a. Assist the patient with ambulation. b. Apply a cold compress on the abdomen. c. Offer a cup of coffee or tea. d. Offer chilled vegetable juice.

ANS: A Ambulation is the most effective method for helping a patient expel gas. Hot or cold beverages and cold compresses will increase gas.

The nurse is aware that an elevated serum amylase is diagnostic of pancreatitis at an early stage as an elevation can be assessed as early as _____ after the onset of pancreatic disease. a. 2 hours b. 8 hours c. 24 hours d. 36 hours

ANS: A An increase in the serum amylase can be detected as early as 2 hours after the onset of pancreatic disease. In simple acute pancreatitis, the level returns to normal in about 36 hours. In chronic disease, it remains elevated.

The nurse is caring for a patient who complains, "I don't see why I can't have a CT scan instead of the expensive MRI!" Which response is most appropriate for the nurse to make? a. "The MRI provides better contrast between normal and pathologic tissue." b. "The MRI requires less analysis and is easier to read." c. "The MRI produces a digital image that can be transmitted via e-mail." d. "The MRI exposes the patient to less radiation."

ANS: A Magnetic resonance imaging (MRI) uses radiofrequency signals to determine how hydrogen atoms behave in the magnetic field. In addition, the MRI provides a better contrast than computed tomography (CT) between healthy tissues and pathologic tissues.

The nurse is reviewing the laboratory results of an assigned patient. The serum bilirubin is 2.8 mg/dL. The nurse anticipates that the patient's urine will display which finding? a. Dark color b. Low specific gravity c. Very scant amount d. Foul odor

ANS: A Normal serum bilirubin is 0.1 to 1.2 mg/dL. Jaundice is present atreadingsabove2.5 mg/dL. The patient who is jaundiced will have dark, tea-colored urine. Specific gravity refers to the concentration of the urine. The amount and odor of urine will not be directly influenced by the bilirubin level

The nurse is percussing a patient's abdomen and hears a dull thud in the right upper quadrant. This sound indicates that nurse is percussing over which location? a. The liver b. The small intestine c. The stomach d. The lungs

ANS: A Percussion is performed by placing the middle finger of one hand on the abdomen and striking the finger lightly below the knuckle and listening for the pitch of sound produced. A dull thud would be heard over the liver. Tympany would be heard over the stomach and intestines, and resonance would be heard over lung tissue

The nurse is caring for a patient who returns to the floor at lunch time after undergoing an upper GI (UGI series). Which action is most important for the nurse to perform first? a. Administer a laxative. b. Educate the patient about the possibility of white stools. c. Offer the patient a small snack. d. Provide oral care.

ANS: A The contrast media used in the series features barium that can harden and lead to an impaction. Patients should have a bowel movement quickly after the procedure to eliminate the medium from the body. While fluids and snacks or meal trays should be given as quickly as possible, patients should be educated about the possibility of white stools for several days post procedure, and oral care should be provided, these interventions are of lesser importance since they do not directly work to quickly prevent a post procedure complication.

During a morning assessment, the nurse observes that a patient displays bulging flanks when supine with the knees flexed. Which action should the nurse take next? a. Measure the patient's abdominal girth. b. Auscultate each quadrant of the abdomen for 5 minutes. c. Document the finding. d. Notify the charge nurse.

ANS: A The nurse's initial assessment indicates fluid accumulation. The nurse needs to obtain more information, first measuring abdominal girth. The nurse can then percuss from the umbilicus to the flanks to detect fluid shifts, and document all findings. The nurse will only auscultate bowel sounds for 5 minutes in each quadrant if bowel sounds are not heard before then. It is unnecessary to notify the charge nurse at this time.

What are the indications for a liver transplant? (Select all that apply.) a. Congenital biliary abnormalities b. Hepatic malignancy c. Chronic hepatitis d. Cirrhosis due to alcoholism e. Gallbladder disease

ANS: A, B, C Indications for liver transplantation include congenital biliary abnormalities, inborn errors of metabolism, hepatic malignancy (confined to the liver), sclerosing cholangitis, and chronic end-stage liver disease.

Which action(s) should the nurse recommend to promote a patient's bowel health? (select all that apply.) a. Exercise regularly. b. Include adequate bulk in the diet. c. Drink adequate water. d. Defecate at approximately the same time every day. e. Take a laxative to maintain a regular defecation pattern

ANS: A, B, C, D Daily exercise and intake of adequate bulk and water are contributions to bowel health. Heeding the need to defecate and defecating at the same time daily will help to keep the gastrocolic reflex healthy. Taking daily laxatives is not conducive to good bowel health

The nurse is caring for a patient immediately following a liver biopsy. Which actions are appropriate for the nurse to take? (select all that apply.) a. Position the patient on the right side. b. Assess the patient's pain. c. Monitor vital signs every 15 minutes for the first hour. d. Instruct patient to cough and deep-breathe. e. Assess for hematoma at puncture site.

ANS: A, B, C, E The liver biopsy is performed under local or general anesthesia. Postprocedural care will include positioning on the right side for the first 2 hours, and assessing pain, vital signs and the puncture site. The patient should not cough as it increases intra-abdominal pressure and may stimulate bleeding

Viral hepatitis may be treated at home. What should be taught to the patient's family? (Select all that apply.) a. Clothes should be laundered separately with hot water. b. Personal items and drinking glasses should not be shared. c. Articles soiled with feces do not require extra care. d. Hands need to be thoroughly washed after toileting. e. Contaminated items may be disposed of with regular trash.

ANS: A, B, D For the patient with viral hepatitis being cared for in the home, the family needs to be taught necessary precautions. Clothes should be laundered separately with hot water. Personal items used by the patient should not be shared. Articles soiled with feces must be disinfected. Any contaminated items should be disposed of properly

The nurse explains that the older adult is prone to digestive disorders related to which age-related change(s)? (select all that apply.) a. Decreased hydrochloric acid b. Increased enzyme levels c. Inadequate chewing d. Diminished intestinal motility e. Gastroesophageal sphincter incompetence

ANS: A, C, D, E Age-related changes that predispose the older adult to digestive disorders include decreased hydrochloric acid, inadequate chewing, diminished intestinal motility, and gastroesophageal sphincter incompetence. Age does not increase digestive enzyme levels.

Which factor(s) increase the risk for developing pancreatic cancer? (select all that apply.) a. Obesity b. Jewish ethnicity c. Diabetes mellitus (DM) d. Hepatitis A e. Smoking

ANS: A, C, E Pancreatic cancer incidence rises steadily with age. Although the cause of pancreatic cancer is not known, the incidence is higher in cigarette smokers. Obesity, chronic pancreatitis, and DM are also risk factors for this cancer. Jewish ethnicity and hepatitis are not contributory to the disease.

The nurse caring for a patient who has had an open cholecystectomy with a T Tube will: a. open the T tube to the air so that it will drain freely. b. position and secure the drainage bag at the chest level. c. place the collection bag so the tube is not kinked. d. irrigate the T tube with normal saline to ensure the free flow of bile.

ANS: B The T tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T tubes are not irrigated.

Which assessment would indicate possible gallbladder disease in an older adult? a. Dull pain in the right upper quadrant region b. Changes in color of urine or stool c. Distention of veins in upper part of body d. Aching muscles and tenderness in the liver

ANS: B The incidence of cholelithiasis increases with aging. Assess older adults for history of changes in stool or urine color. Cirrhosis of the liver may cause distention in veins in the upper part of the body.

What should the nurse explain is the major purpose of the Sengstaken-Blakemore tube (S/B tube)? a. Decompress the stomach. b. Control esophageal varices bleeding. c. A route for tube feedings. d. Obtain specimen for gastric analysis.

ANS: B The major purpose of the S/B tube is to control bleeding by pressure against the vessels in the esophagus. The two balloons of the tube are inflated to put direct pressure on the esophagus and are anchored by the inflated balloon in the stomach. The tube can suction blood from the stomach as well.

The nurse clarifies that unconjugated bilirubin, which is made up of broken-down red cells, is: a. stored in the gallbladder to make bile. b. water-insoluble bilirubin that must be converted by the liver. c. a by-product which is excreted directly into the bowel for excretion. d. necessary for digestion of fats.

ANS: B Unconjugated bilirubin is a water-insoluble product that must be converteterm-52d in the liver to conjugated bilirubin (water soluble) so that it may be excreted through the bowel.

A patient with a T tube for an open cholecystectomy has resumed oral intake. The T tube is clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of fat. During the time the tube is clamped the patient complains of abdominal pain and nausea. Which intervention is most appropriate? a. Notify the physician. b. Unclamp the tube immediately. c. Increase the IV fluids. d. Change the T-tube dressing.

ANS: B While the tube is clamped, the patient may show signs of abdominal pain, nausea, vomiting, etc. Unclamp the tube immediately to allow for drainage and relief of both nausea and pain

The nurse is assessing a patient's bowel sounds. After auscultating each quadrant for 30 seconds, the nurse fails to hear any sounds. How should the nurse document this finding? a. Absent bowel sounds b. Hypoactive bowel sounds c. Active bowel sounds d. Hyperactive bowel sounds

ANS: B Hypoactive bowel sounds can be noted in the medical record when no sounds are heard after listening in each of the four quadrants for 30 seconds. For bowel sounds to be considered absent, it is necessary to verify that no sounds are heard after listening in each of the four quadrants for 5 minutes. If hyperactive, high-pitched sounds are heard in one quadrant, and decreased sounds are heard in another quadrant, assess for nausea and vomiting, as the patient may have an intestinal obstruction.

The nurse is planning care for a patient who has experienced moderate diarrhea for 3 days. Which collaborative intervention is most important to include in the plan of care? a. Place the patient on NPO status. b. Limit the patient's diet to clear liquids. c. Administer parenteral nutrition. d. Restrict the patient's diet to soft foods only.

ANS: B If diarrhea is moderate, only clear liquids are permitted by mouth. If the diarrhea is severe, nothing is given by mouth until it subsides. Severe, long-term diarrhea may require the use of total parenteral nutrition. When diarrhea is caused by infection, stool cultures and antibiotics may be necessary. As the condition improves, the diet is advanced.

The home health nurse is caring for the patient with tuberculosis who is taking rifampin and isoniazid (INH). The nurse should carefully monitor the patient for which potential side effect? a. Gallstones b. Liver disorders c. Bleeding ulcers d. Esophagitis

ANS: B Rifampin and INH are both hepatotoxic.

The nurse caring for an 80-year-old woman who is undergoing the extensive bowel preparation for a colonoscopy. The nurse should most closely monitor the patient for which potential complication? a. Diarrhea b. Metabolic acidosis c. Fatigue d. Dyspnea

ANS: B The older patient is especially at risk for problem of electrolyte imbalance, fluid overload, or dehydration when undergoing preparation for diagnostic tests that require a fasting state and/or bowel cleansing. Metabolic acidosis can occur when there is a large volume loss of bowel content. Bowel preparation causes diarrhea and may cause fatigue; bowel preparation should not cause dyspnea

Before a nurse can document the presence of diarrhea, which criteria must be met? (select all that apply.) a. One loose stool in a 24-hour period b. Multiple liquid or semiliquid stools in a 24-hour period c. Hyperactive bowel sounds d. Cramping e. Fever

ANS: B, C, D Multiple liquid or semiliquid stools in a 24-hour period with hyperactive bowel sounds with cramping are the criteria for diarrhea. Fever is not a diagnostic criteria for diarrhea, and a single loose stool is merely documented as such.

The nurse is caring for a patient with anorexia nervosa. Which intervention(s) might the nurse use to stimulate appetite? (select all that apply.) a. Offer oral care after meals. b. Arrange for preferred foods to be served. c. Encourage family members to bring food from home. d. Suggest that family members or friends come and socialize during the meal. e.Allow ampletime to eat and enjoy themeal

ANS: B, C, D, E Appetite depends on complex mental processes having to do with memory and mental associations that can be pleasant or extremely unpleasant. Appetite is stimulated by the sight, smell, and thought of food. The physical and social environment in which a person is eating stimulates appetite. The enjoyment of eating can be inhibited by unattractive or unfamiliar food, by unpleasant surroundings, and by emotional states such as anxiety, anger, and fear. By serving food based on patient's preferences, encouraging positive interaction, and allowing ample times for meals, the nurse can stimulate appetite. Oral care should be offered before meals to aid in stimulating the appetite.

What should the nurse do as part of the preparation for an endoscopic retrograde cholangiopancreatography (ERCP)? (Select all that apply.) a. Confirm that a recent chest x-ray is on file. b. Confirm the presence of a consent form. c. Warn patient that the procedure will take about 3 hours. d. Confirm the presence of a prothrombin time/INR. e. Withhold food and drink for 4 hours.

ANS: B, D Before the ERCP, the patient will be held NPO for 8 hours. It is necessary that a consent form be signed as well as evidence of a prothrombin time INR.

The nurse is caring for a patient scheduled to have an MRI study. Which instruction(s) should the nurse include in the teaching? (select all that apply.) a. Radiation exposure is extremely minimal. b. All metal objects, including dental bridges, jewelry, and body piercings, must be removed. c. Do not eat or drink for 4 hours before the procedure. d. A radiopaque medium may be injected during the procedure. e. There may be a tingling sensation in metal alloy filling of the teeth

ANS: B, D, E The MRI places the patient in a magnetic field and uses radiofrequency signals to determine how hydrogen atoms behave in the field. All metal must be removed, contrast medium may be injected, and the patient may have a tingling sensation in the teeth with metal alloy fillings. There is no restriction on food or fluid intake in relation to the test. The test does not expose the patient to radiation.

The nurse is aware that the liver synthesizes products essential to health. Which products are synthesized by the liver? (Select all that apply.) a. Intrinsic factor b. Protein c. Vitamin K d. Red blood cells e. Albumin

ANS: B, E The liver synthesizes protein and albumin.

Why is morphine contraindicated in the patient with pancreatitis? a. Demerol (meperidine) is less expensive. b. Tylenol is more effective at managing this type of pain. c. Morphine may cause spasms of the sphincter of Oddi. d. These patients do not experience pain.

ANS: C A common complaint is constant, severe pain; in such cases, meperidine (Demerol) PCA is often administered. Morphine may cause spasms of the sphincter of Oddi.

The nurse would make provisions in the plan of care for a person who has had a liver transplant to prevent: a. fluid congestion. b. fatigue. c. infection. d. urinary retention.

ANS: C A critical aspect of nursing care following liver transplantation is monitoring for infection. The major postoperative complications of a liver transplant are rejection and infection.

Why is it advantageous for a live person to be a liver donor? a. Because the donor is not at risk for any complication. b. Because the recipient is more likely to avoid rejection. c. Because the donor donates only a part of the liver. d. Because the blood supply is more dependable in the donated liver.

ANS: C A live donor may donate only a portion of their liver and within weeks the donor's liver has grown to the size to meet the body's needs. The same is true for the recipient.

Which of the following is a classic symptom of cholecystitis? a. Substernal, radiating to the left shoulder and arm b. Epigastric, radiating to the back c. Right upper abdomen, radiating to the back or right scapula d. Left upper abdomen, radiating to the jaw and neck

ANS: C It localizes in the right upper quadrant epigastric region. The pain radiates around the mid torso to the right scapular area.

What should the nurse expect of a patient with a malabsorption of vitamin K? a. Lowered hemoglobin b. Elevated hematocrit c. Increased prothrombin time d. Diminished white blood cell count

ANS: C Prothrombin times are increased because malabsorption of vitamin K or inability to produce the clotting factors VII, IX, and X cause the patient to have bleeding tendencies

How does the administration of neomycin (Mycifradin) reduce the production of ammonia? a. By assisting the hepatic cells to regenerate b. By reducing ascites c. By decreasing the bacteria in the gut d. By helping to digest fats and proteins

ANS: C The buildup of ammonia can be prevented with the use of lactulose (Chronulac) and neomycin. Ammonia is produced in the gut by bacterial action. By reducing the bacteria, less ammonia is produced.

What should the nurse monitor in caring for the patient undergoing a paracentesis? a. The urinary output b. Hypervolemia c. Fluid removal over at least 30 minutes d. Seizure

ANS: C The fluid removed during a paracentesis is removed over a period of 30 to 90 minutes to prevent sudden changes in blood pressure leading to syncope. The bed should be in a high Fowler's position. Food and fluid restriction is usually not necessary.

What should the nurse do to prepare a patient for an oral cholecystography? a. Ensure that the patient drinks 500 mL of water before testing. b. Give 4 Oragrafin (ipodate) 5 minutes apart starting at 6 a.m. c. Administer 6 Telepaque (iopanoic acid) tablets 5 minutes apart after the evening meal. d. Give a fatty meal 1/2 hour before the test is started.

ANS: C The patient is held NPO and given 6 tablets 5 minutes apart the evening before the procedure after the evening meal. A fatty meal is given to the patient after the test is started to stimulate emptying of the gallbladder.

The nurse cautions that constant stress can cause which alteration to the gastrointestinal (GI) system? a. Slowed GI mobility resulting in constipation b. Reversed peristalsis resulting in projectile vomiting c. Increased digestive juices resulting in a gastric ulcer d. Decreased digestive juices resulting in ineffective metabolism

ANS: C Stress increases the gastric secretions, which irritate and finally ulcerate the gastric mucosal lining.

The nurse is caring for a patient who has been experiencing severe diarrhea and can now resume solid foods. The nurse educates the patient about appropriate food choices. Which food choice indicates that the nurse's teaching has been successful? a. Whole-grain rice b. Wheat toast c. Applesauce d. Grapes

ANS: C When a patient has severe diarrhea and is allowed to resume solid foods, the foods should be slowly introduced in order to help thicken the stool. Foods such as applesauce, pretzels, bananas, white rice, white toast, and yogurt are beneficial

The nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug: a. increases the rate of the regeneration of liver cells. b. can overcome complications presented by hepatitis C. c. increases blood supply to transplant. d. does not suppress bone marrow.

ANS: D Cyclosporine is an immunosuppressant that does not cause bone marrow suppression nor does it impede healing.

A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T tube inserted into the common bile duct. What is the purpose of the T tube? a. To decompress the duct and relieve pain caused by stimulation of the sphincter of Oddi. b. To improve diaphragmatic expansion and prevention of atelectasis. c. To shorten postoperative recovery and hasten the healing process. d. To keep the duct open and allow drainage of the bile until edema resolves.

ANS: D If the stones are in the common bile duct and edema is present, a biliary drainage tube, or T tube, will be inserted to keep the duct open and allow drainage of the bile until the edema resolves

The nurse is aware that the hepatitis A immunization provides immunity in: a. 5 days. b. 10 days. c. 15 days. d. 30 days.

ANS: D Primary immunization with hepatitis A vaccine provides immunity within 30 days.

Which factors may increase a patient's risk of developing cancer of the pancreas? a. Diet high in carbohydrates and dairy products b. Cardiovascular disease and glaucoma c. Tea and cola consumption d. Cigarette smokers and people with diabetes mellitus

ANS: D The cause of cancer of the pancreas is unknown, but it is diagnosed more often in cigarette smokers, people exposed to chemical carcinogens, and people with diabetes mellitus and pancreatitis

What should the nurse point out as a significant advantage of the laparoscopic cholecystectomy? a. Slightly more invasive, but there is less pain b. Can be performed on all patients of any age c. Can be performed even when there are large stones present in the bile duct d. Less invasive procedure

ANS: D The laparoscopic cholecystectomy is less invasive and causes less pain and a quick recovery. If there are large stones present, a sphincterotomy is done before the laparoscopic cholecystectomy. Persons with bleeding tendencies, pathologic conditions of the abdomen, stones in the bile duct, and extensive adhesions are not good candidates.

What is an essential nursing measure to prevent injury to the patient who is to receive a paracentesis? a. Have patient sign a permit. b. Pad side rails. c. Check for allergy to contrast media or to shellfish. d. Have patient void immediately before procedure.

ANS: D To prevent the puncturing of the bladder, the patient must void immediately before the procedure. A permit is required but it is not a safety precaution for the patient. There is no contrast media used in a paracentesis.

The nurse assisting in the treatment of a patient with ruptured esophageal varices who has received vasopressin IV will carefully assess for: a. muscular twitching/spasm. b. hematuria. c. macular rash on trunk and arms. d. evidence of cardiac ischemia.

ANS: D Vasopressin is a strong vasoconstrictor given to try to stop the hemorrhage of the varices. Unfortunately it also constricts all vessels and may cause cardiac ischemia.

The nurse is preparing to administer liquid laxative to a patient in preparation for a colonoscopy. Which action should the nurse take? a. Offer a small snack. b. Take the patient's temperature. c. Mix the laxative with orange juice. d. Chill the laxative and pour it over ice.

ANS: D Chilling the laxative or pouring it over ice makes the drink more palatable and easier to swallow. The nurse should not offer any food, as the accuracy of the test depends on adequate bowel prep. The laxative does not affect the patient's temperature. Mixing the laxative with another substance can make it difficult to judge how much the patient actually consumed if any liquid is remaining.

The nurse is caring for multiple patients. The nurse determines that which patient has the highest risk for developing gallstones? a. A 37-year-old white man of normal weight on long-term corticosteroids for asthma. b. A 42-year-old African American man of normal weight who has smoked for 25 years. c. A 46-year-old Indonesian woman who is under normal weight and has recently had radiation treatments. d. A 50-year-old obese Mexican American woman who has type 1 diabetes.

ANS: D Obesity, diabetes mellitus (DM), rapid weight loss, and Crohn disease increase the risk for the development of gallstones. Native Americans and Mexican Americans have an ethnic predisposition to gallstones.

The nurse is obtaining a history of a patient with hepatitis A. Which question is most appropriate for the nurse to ask? a. "If using drugs, do you share needles?" b. "Do you always practice safe sex?" c. "Have you traveled to Canada in the last month?" d. "Do you eat shellfish or oysters often?"

ANS: D Shellfish and mollusks can be contaminated by living in feces-contaminated water. Drug use and unprotected sex are not part of the etiology of hepatitis A but are for hepatitis B. Travel to Canada is not associated with hepatitis A.

The nurse is reviewing a student nurse's charting and notes that the student has documented absent bowel sounds. The nurse reminds the student that in order to document absent bowel sounds, one must auscultate each quadrant at what period of time? a. 30 seconds b. 1 minute c. 2 minutes d. 5 minutes

ANS: D The criterion for the documentation of absent bowel sounds is that each quadrant is auscultated for 5 minutes.

The nurse is performing preprocedure teaching for a patient scheduled to undergo a liver biopsy. After listening to the information, the patient states, "I am so scared. I just don't know if I can do this procedure." Which response is best? a. "The procedure will only last about 15 minutes." b. "Most patients say it feels similar to a punch in the shoulder." c. "You do not have to have the procedure." d. "I understand that you are afraid. Tellme more about your concerns

ANS: D The nurse should acknowledge the patient's feelings and promote therapeutic communication. While all of the other statements are true, none of them investigate the underlying cause of the patient's fear. Reassurance about the length of the procedure or the sensation that the patient might experience may be indicated after the patient explains more about specific concerns. While the patient can refuse to have the procedure, dismissing the patient is not an appropriate or therapeutic statement.

What is the second step in the normal process of protein metabolism? a. Protein enters the bloodstream. b. Excreted by kidney. c. Portal vein delivers blood to the liver. d. Conversion to urea. e. Ammonia produced in the bowel.

ANS: E Protein products enter the bloodstream and are changed in the bowel to ammonia; the products then pass through the portal vein to the liver where the ammonia is converted to urea, which is then excreted by the kidneys.

The nurse caring for the patient who has diarrhea from taking a protocol of oral amoxicillin will use Precautions in the care.

ANS: Standard standard The diarrhea caused by medications is not infectious and should be dealt with using Standard Precautions

Match each term with its correct definition. a. Absorption b. Peristalsis c. Metabolism d. Anabolism e. Catabolism

B=Rhythmic squeezing action of intestinal tract C=Chemical process to make substances needed by the body D-=Repair of body tissue E-Breaking down larger molecules into smaller molecules A-Transfer of nutrients from intestine to bloodstream