CHAPTER 47
A client had an open cholecystectomy with a T-tube insertion, and the nurse is measuring the bile drainage every 8 hours. When should the nurse notify the physician? A)If more than 500 mL of bile drainage is present in 24 hours. B)If the bile drainage is dark green. C)If there is 100 mL in the drainage pouch after 8 hours. D)If there is 10 mL/hour of drainage in 24 hours.
A
A client has been diagnosed with Laennec's cirrhosis. What does the nurse understand that this type of cirrhosis is caused by? A)Chronic alcohol intake B)Infection C)Scarring around the bile ducts D)Autoimmune response
A
A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis? A)A liver biopsy B)A CT scan C)A prothrombin time D)Platelet count
A
A patient with cirrhosis is complaining to the nurse of itching. The client asks the nurse if the itching is because he has been taking warm baths. What is the best response by the nurse? A)"The itching is caused by the accumulation of bile salts." B)"The itching is related to dry skin from the warm baths." C)"The itching is most likely a side effect from some of the medications used in treatment." D)"The itching is related to a psychological response from the illness."
A
Which of the following symptoms would indicate that a client with chronic pancreatitis has developed secondary diabetes? A)Increased appetite and thirst B)Vomiting and diarrhea C)Low blood pressure and pulse D)Decreased urination and constipation
A
A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding? A)Vitamin K B)Octreotide (Sandostatin) C)Vasopressin (Pitressin) D)Epinephrine
B
A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? A)Potassium B)Vitamin K C)Vitamin B D)Oral bile acids
B
The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed? A)Thoracentesis B)Abdominal paracentesis C)Abdominal CT scan D)Upper endoscopy
B
The nurse is administering medications to a patient that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? A)Spironolactone (Aldactone) B)Cholestyramine (Questran) C)Lactulose (Cephulac) D)Kanamycin (Kantrex)
C
When inspecting the abdomen of a client with cirrhosis, the nurse observes that the veins over the abdomen are dilated. The nurse documents this finding as which of the following? A)Gynecomastia B)Cutaneous spider angiomata C)Caput medusae D)Palmar erythema
C
A client with severe acute pancreatitis has a glucose level of 750 mg/dL. What does the nurse understand is the cause of this level of hyperglycemia? A)Increase in circulating calcium B)The client has not been taking the insulin and eating simple carbohydrates. C)The client has diabetes as well as pancreatitis. D)Imbalance of glucagon, insulin, and somatostatin
D
When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? A)Yellow-green B)Black and tarry C)Blood tinged D)Clay-colored or whitish
D
A client with cirrhosis is complaining of severe pruritus related to the accumulation of bile salts. What can be prescribed for the client to relieve the itching? A)Cholestyramine (Questran) B)Kanamycin (Kantrex) C)Lactulose (Cephulac) D)Cyclosporine (Sandimmune)
A
The nurse is administering furosemide (Lasix) to promote urinary excretion of excess fluids for a client with cirrhosis. When administering Lasix to this client, what should the nurse closely monitor? A)Potassium level B)Calcium level C)Magnesium level D)AST levels
A
The nurse is reviewing laboratory work that is consistent with a client being positive for hepatitis and in the incubation phase of the illness. What should the nurse be concerned with at this stage of the illness? A)The client is infectious. B)The client may have enlargement of the liver and spleen. C)The client will have weight loss. D)The client has jaundice.
A
The nurse is caring for a client with cirrhosis of the liver. What symptoms exhibited by the client would indicate to the nurse that he is experiencing central nervous system effects of the disease? Select all that apply. A)Asterixis B)Joint stiffness C)Positive Babinski reflex D)Cough E)Fetor hepaticus
A,C,E
A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide? A)Normal activities may be resumed the day after surgery. B)Normal activities may be resumed in 1 week. C)Normal activities may be resumed in 2 weeks. D)Normal activities may be resumed in 1 month.
B
A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor? A)Elevated white blood cell count B)Elevated alpha-fetoprotein C)Decreased AST levels D)Decreased alkaline phosphatase levels
B
A client with esophageal varices is scheduled to undergo injection sclerotherapy. Which of the following client statements indicates that the teaching was successful? A)"The physician will use a balloon to compress the vessels." B)"I might need to have this procedure done again." C)"It's seems odd that a rubber band can block off the vessels." D)"A catheter will be inserted through my belly to fix the vessels."
B
A client with gallstones tells the nurse, "The doctor has to do something. Isn't there something he can give me to dissolve them?" What medication does the nurse know may help dissolve the gallstones? A)Pancreatin (Creon) B)Chenodiol (Chenix) C)Tacrolimus (Prograf) D)Cyclosporine (Sandimmune)
B
What medication will the nurse administer to the client with pancreatitis in order to reduce the activity of the vagus nerve? A)Pancreatin (Creon) B)Atropine C)Famotidine (Pepcid) D)Omeprazole (Prilosec)
B
When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? A)Report the condition to the physician immediately. B)Measure abdominal girth according to a set routine. C)Provide the client with nonprescription laxatives. D)Ask the client about food intake.
B
Which of the following interventions would be appropriate for a client who has undergone surgery for a liver disorder and has started shivering? A)Provide the client with warm fluids. B)Cover the client with a light blanket. C)Ensure that the room temperature is below 70° F. D)Place the client on a hypothermia blanket.
B
A client comes to the clinic and informs the nurse that he is there to see the physician for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with? A)Hepatitis B)Biliary colic C)Cholelithiasis D)Cholecystitis
C
A client has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has? A)Hemolytic jaundice B)Hepatocellular jaundice C)Obstructive jaundice D)Cirrhosis of the liver
C
A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction? A)Paracentesis B)Liver transplantation C)High-dose corticosteroids D)Azathioprine (Imuran)
C
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? A)Cure the cirrhosis. B)Treat the esophageal varices. C)Reduce fluid accumulation and venous pressure. D)Promote optimal neurologic function.
C
A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? A)Chenodiol (Chenix) B)Ursodiol (Actigall) C)Tacrolimus (Prograf, FK506) D)Interferon alfa-2b, recombinant (Intron A, Roferon-A)
C
A female client with chronic hepatitis B has been prescribed recombinant interferon alfa-2b (Intron A, Roferon-A) in combination with ribavirin (Rebetol). Which of the following instructions should a nurse provide this client? A)Avoid calcium-rich foods. B)Maintain an exercise regimen. C)Use strict birth control methods. D)Avoid hot water baths or soaks.
C
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? A)Hepatitis B is transmitted primarily by the oral-fecal route. B)Hepatitis A is frequently spread by sexual contact. C)Hepatitis C increases a person's risk for liver cancer. D)Infection with hepatitis G is similar to hepatitis A
C
The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis? A)Dull pain, points to epigastric area B)Sharp, stabbing pain in the left lower quadrant of the abdomen C)Severe midabdominal to upper abdominal pain radiating to both sides and to the back D)Severe abdominal pain that radiates to the right shoulder
C
The nurse is admitting a client to their room at the hospital and observes that the client's skin and sclera are jaundice. What does the nurse expect the client's total bilirubin levels to be? A)0.2 mg/dL B)1.0 mg/dL C)2.0 mg/dL D)3.0 mg/dL
D
The nurse would expect to observe which of the following when assessing a client with cholelithiasis? A)Stools that contain blood and mucus B)Bowel sounds that are absent C)Stools that appear small and dry D)Urine that appears dark brown
D
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? A)Colonoscopy B)Abdominal x-ray C)Cholecystectomy D)Endoscopic retrograde cholangiopancreatography (ERCP)
D