concepts 3 exam 5
The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs further teaching if the client makes which statement? -"I know I must sign the consent form" -"I hope the throat spray keeps me from gagging" -"I'm glad I don't have to lie still for this procedure" -"I'm glad some intravenous medication will be given to relax me"
"I'm glad I don't have to lie still for this procedure"
A 28 year old client involved in a motor vehicle crash is brought to the emergency department. What clinical sign would alert you to the presence of possible liver trauma? -abdominal pain referred to the right shoulder -right quadrant abdominal pain and swelling -abdominal pain that is referred to the spine -abdominal pain with accompanying rebound tenderness
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The primary health care provider has determined that a client has contracted hepatitis A based on flu-like symptoms and jaundice. Which statement made by the client supports the medical diagnosis? -"I have had unprotected sex with multiple partners" -"I ate shellfish about 2 weeks ago at a local restaurant" -"I was an IV drug abuser in the past and shared needles" -"I had a blood transfusion 30 years ago after major abdominal surgery"
-"I ate shellfish about 2 weeks ago at a local restaurant"
What statement made by a client who is traveling to a non industrialized country indicates the need for further teaching regarding the prevention of viral hepatitis? -"when traveling out of the country, I will drink bottled water" -"I will not share my drinking glass" -"I should eat plenty of fresh fruit" -"I'll use careful handwashing"
-"I should eat plenty of fresh fruit"
which question should the nurse ask when assessing risk factors for pancreatic cancer?
-"do you have a history of chronic pancreatitis?"
You are providing education to a patient with an active hepatitis B infection. What will you include in their discharge instructions? SATA: -"take acetaminophen as needed for pain" -"eat large meals that are spread out through the day" -"follow a diet low in fat and high in carbs" -"do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product" -"perform aerobic exercises daily to maintain strength"
-"follow a diet low in fat and high in carbs" -"do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product"
A client with advanced cirrhosis has begun treatment with Lactulose. The client reports experiencing several soft stools per day. What is your best response? -"this is the normal expected response to this medicine" -"you may take Kaopectate liquid 3 times per day for loose stools" -"do not take any more of the medication until I check with your physician" -"we will need to send a stool specimen to the lab for culture and sensitivity"
-"this is the normal expected response to this medicine"
A client who underwent liver transplantation 2 weeks ago reports a temperature of 101 and right flank pain. What would be your best response? -"the immunosuppressive drugs you are taking may make you susceptible to infections" -"you may be rejecting the transplanted liver and should go to the hospital immediately" -"you should take an additional dose of cyclosporine daily" -"take acetaminophen every 4 hrs until you feel better"
-"you may be rejecting the transplanted liver and should go to the hospital immediately"
A client diagnosed with hepatitis A asks you how the infection may have been contracted. What is your best response? -"some medications have been known to induce hepatitis A" -"you may have been exposed through contaminated shellfish" -"you may have been infected through a recent blood transfusion" -"you have had Epstein-Barr virus before, and hepatitis A can co-infect you"
-"you may have been exposed through contaminated shellfish"
A patient was exposed to hepatitis B recently. Postexposure precautions include vaccination and administration of HBIg (hepatitis B immune globulin). HBIg needs to be given as soon as possible, preferably how many weeks after exposure, to be effective? -2 weeks -24 hours -1 month -7 days
-24 hours
Which of the following clients is most at risk of developing hepatitis B? -24 year old college student who has had several sexual partners -54 year old woman who takes acetaminophen daily for headaches -33 year old businessman who travels frequently -72 year old woman who has eaten raw shellfish
-24 year old college student who has had several sexual partners
A client diagnosed 8 months ago with hepatitis B is suspected of having chronic hepatitis. What serologic marker would you expect to be present if this client is indeed a carrier of the disease? -anti-HCV antibodies -anti-HBs antibodies -HBsAg antibodies -HAV antibodies
-HBsAg antibodies
The nurse is completing a health history and physical assessment on a client admitted with esophageal varices and cirrhosis. What signs and symptoms alert the nurse to a potential internal hemorrhage? -HR 110, temp 102.2, and flushed appearance -HR 80, temp 99.1, pain in the right lower quadrant, and constipation -HR 108, temp 97.7, RR 28, and nausea -HR 60, temp 102.2, rebound tenderness in the right lower quadrant, and diarrhea
-HR 108, temp 97.7, RR 28, and nausea
What is the most common transmission route of hepatitis C? -blood transfusion -sharps injury -long-term dialysis -IV drug use
-IV drug use
The nurse correlates which clinical manifestation to cholecystitis? -retroperitoneal pain -absence of bowel sounds -diarrhea -RUQ pain
-RUQ pain
The nurse recognizes which patient is at greatest risk for type 1 autoimmune hepatitis? -a 45 year old postmenopausal female -a 30 year old female with a history of hyperthyroidism -a 16 year old female with type I diabetes -a 12 year old female with autism
-a 16 year old female with type I diabetes
Which patient below is at most risk for developing a complication related to a hepatitis E infection? -a 45 year old male with diabetes -a 26 year old female in the 3rd trimester of pregnancy -a 12 year old female with a ventricular septal defect -a 63 year old male with cardiovascular disease
-a 26 year old female in the 3rd trimester of pregnancy
Which of the following patient's should the nurse assess first? -a 40 yr old patient with chronic pancreatitis who has gnawing abdominal pain -a 58 yr old patient who has compensated cirrhosis and is complaining of anorexia -a 55 yr old patient with cirrhosis and ascites who has an oral temperature of 102 -a 36 yr old patient recovering from a laparoscopic cholecystectomy who has severe shoulder pain
-a 55 yr old patient with cirrhosis and ascites who has an oral temperature of 102
What assessment finding would you expect to note in a client with cirrhosis who is exhibiting fetor hepaticus? -purpuric lesions on the extremities -a fruity or musty breath odor -warm and bright red palms -jaundice of the sclera
-a fruity or musty breath odor
A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patient's treatment, the nurse should anticipate what intervention? -administration of immune globulins -a regimen of antiviral medications -rest and watchful waiting -administration of fresh frozen plasma
-a regimen of antiviral medications
A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health promotion teaching has the most potential to prevent drug-induced hepatitis? -finish all prescribed courses of antibiotics, regardless of symptom resolution -adhere to dosing recommendations of over-the-counter analgesics -ensure that expired medications are disposed of safely -ensure that pharmacists regularly review drug regimens for potential interactions
-adhere to dosing recommendations of over-the-counter analgesics
he nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions should the nurse expect to note? SATA: -administer antacids as prescribed -encourage small, frequent high calorie feedings -encourage coughing and deep breathing -administer anticholinergics as prescribed -maintain the client in a supine and flat position
-administer antacids as prescribed -encourage coughing and deep breathing -administer anticholinergics as prescribed
Which actions are most appropriate when caring for a patient with liver cancer? SATA: -administer nerve blocks locally and directly into the nerves of the abdomen -include plenty of fluids and protein rich foods -administer antibiotics and antipyretics to the patient -keep the lower extremities at a lower level -administer nonsteroidal anti-inflammatory medications to the patient
-administer nerve blocks locally and directly into the nerves of the abdomen -administer antibiotics and antipyretics to the patient -administer nonsteroidal anti-inflammatory medications to the patient
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? -assess heart and lung sounds -administer the prescribed analgesic -position the patient on the operative side -instruct the patient to cough and deep breathe
-administer the prescribed analgesic
A patient with cirrhosis who is being treated with spironolactone and lasix has a serum sodium level of 135 mEq/L and a serum potassium level of 3.2 mmol/L. Before notifying the health care provider, the nurse should: -administer the lasix and withhold the spironolactone -give both drugs as scheduled -administer the spironolactone -withhold both drugs until talking with the health care provider
-administer the spironolactone
Which abnormal laboratory value associated with liver failure is correct? SATA: -albumin level is decreased -total bilirubin is elevated -platelets are increased -partial thromboplastin time is prolonged -ammonia level is decreased -decreased alkaline phosphatase -prolonged prothrombin time
-albumin level is decreased -total bilirubin is elevated -partial thromboplastin time is prolonged -prolonged prothrombin time
what should the nurse assess a pt for before undergoing a HIDA scan?
-allergies to iodine, seafood, or contrast media
A patient with hepatitis is extremely confused. The patient is diagnosed with hepatic encephalopathy. What lab result would correlate with this mental status change? -ammonia 100 mcg/dL -bilirubin 7 mg/dL -ALT 56 U/L -AST 10 U/L
-ammonia 100 mcg/dL
The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful? -bilirubin <1 mg/dL -ALT 8 U/L -ammonia 16 mcg/dL -AST 10 U/L
-ammonia 16 mcg/dL
Which pancreatic enzyme breaks down starches? -amylase -secretin -lipase -trypsin
-amylase
A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise the individuals who ate at this restaurant and who have never received the hepatitis A vaccine to obtain? -the hepatitis A vaccine -albumin infusion -the hepatitis A and B vaccines -an immunoglobulin injection
-an immunoglobulin injection
Which patient's below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? SATA: -a 55 year old male with hepatitis A -an infant who contracted hepatitis B at birth -a 32 year old female with hepatitis C who reports using IV drugs -a 50 year old male with alcoholism and hepatitis D -a 30 year old who contracted hepatitis E
-an infant who contracted hepatitis B at birth -a 32 year old female with hepatitis C who reports using IV drugs -a 50 year old male with alcoholism and hepatitis D
A client with acute hepatitis B has begun treatment with ribavirin (virazole). What manifestation would alert you to a serious side effect of this medication? -anemia -pedal edema -sensory neuropathy -decreased gastric motility
-anemia
The nurse is assessing a client who is in the early stages of cirrhosis of the liver. Which focused assessment is appropriate? -peripheral edema -ascites -anorexia -jaundice
-anorexia
The nurse assesses for which clinical manifestations in the patient diagnosed with liver cancer? SATA: -periumbilical pain -anorexia -hemoptysis -fatigue -jaundice
-anorexia -fatigue -jaundice
The nurse is performing an assessment on a client being evaluated for viral hepatitis. Which symptom will the nurse most likely assess on this client? -arthralgia -excitability -headache -polyphagia
-arthralgia
Select all the signs and symptoms associated with hepatitis: -arthralgia -bilirubin 1 mg/dL -ammonia 15 mcg/dL -dark urine -vision changes -yellowing of the sclera -fever -loss of appetite
-arthralgia -dark urine -yellowing of the sclera -fever -loss of appetite
A TIPS procedure is used to treat which complication of liver cirrhosis? -ascites -portal hypertension -hepatic encephalopathy -spontaneous bacterial peritonitis
-ascites
A patient with late stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? -increased albumin levels -ascites -splenomegaly -fluid volume deficit -esophageal varices
-ascites -splenomegaly -esophageal varices
A client presents with cirrhosis of the liver secondary to alcohol abuse. Which assessment finding would warrant immediate action by the nurse? -ascites and hematemesis -pulmonary edema -jugular vein distention -cramps and watery diarrhea
-ascites and hematemesis
A patient born in 1955 had hepatitis A 1 year ago. According to the CDC, which action should the nurse include in care when the patient is seen for a routine annual physical exam? -start the hepatitis B immunization series -teach the patient about hepatitis A immune globulin -ask whether the patient has been screened for hepatitis C -test for anti-HAV IgM
-ask whether the patient has been screened for hepatitis C
A patient with liver cancer is being discharged home with a biliary drainage system in place. The nurse should teach the patient's family how to safely perform which of the following actions? -aspirating bile from the catheter using a syringe -removing the catheter when output is 15 mL/24 hrs -instilling antibiotics into the catheter -assessing the patency of the drainage catheter
-assessing the patency of the drainage catheter
The nurse helps the patient with a T-tube get up from the bed and sit in the bedside chair. Where will the nurse make it priority to position the tubing and drainage bag of the T-tube? -slightly elevated above the T-tube insertion site -at heart level -midline with the T-tube insertion site -at or below the waist
-at or below the waist
A patient has lab work drawn and it shows a positive HBsAg. What education will you provide to the patient? -avoid sexual intercourse or intimacy such as kissing until blood work is negative -the patient is now recovered from a previous hepatitis B infection and is now immune -the patient is not a candidate from antiviral or interferon medications -the patient is less likely to develop a chronic infection
-avoid sexual intercourse or intimacy such as kissing until blood work is negative
A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced activity. What is the rationale for this intervention? -bed rest reduces the patients metabolism and reduces the risk of metabolic acidosis -reduced activity protects the physical integrity of pancreatic cells -bed rest lowers the metabolic rate and reduces enzyme production -inactivity reduces caloric need and gastrointestinal motility
-bed rest lowers the metabolic rate and reduces enzyme production
a client has RUQ abdominal pain, jaundice, weight loss, and an elevated serum CA 19-9. Which condition does the nurse suspect?
-bile duct cancer
what type of cirrhosis can be caused by chronic biliary obstruction and infection (cholangitis)
-biliary cirrhosis
A patient has just returned from an ERCP procedure for the removal of gallstones. The nurse should monitor the patient for signs of what complications? -pain and peritonitis -bleeding and perforation -acidosis and hypoglycemia -gangrene of the gallbladder and hyperglycemia
-bleeding and perforation
A client with end stage cirrhosis develops severe vomiting and is admitted to a medical-surgical unit. What complication of cirrhosis should the nurse be alert for in this client? -intrahepatic bile stasis -bleeding esophageal varices -decreased excretion of bilirubin -the accumulation of plasma within the peritoneal cavity
-bleeding esophageal varices
A patient with cirrhosis is being considered for liver transplantation. How will the patient's prioritization for receiving a donor liver be determined? -by considering the patient's age and prognosis -by objectively determining the patient's medical need -by objectively assessing the patient's willingness to adhere to post-transplantation care -by systematically ruling out alternative treatment options
-by objectively determining the patient's medical need
The laboratory report of a patient with gallstones reveals increased liver enzymes in the blood. Which medication is most likely to be prescribed to this patient? -demerol -naproxen -chenodiol -acetaminophen
-chenodiol
a client has RUQ pain, fever, dark colored urine, jaundice, clay colored stools, and an increased bilirubin. What diagnosis does the nurse expect?
-cholangitis
The nurse teaches a client who has been recently diagnosed with hepatitis A about signs and symptoms related to hepatitis that may develop. The one that should be reported immediately to the physician is: -restlessness -yellow urine -nausea -clay colored stools
-clay colored stools
A female nurse sticks herself with a contaminated needle. Which action should the nurse implement first? -notify the infection control nurse -cleanse the area with soap and water -request postexposure prophylaxis -check the hepatitis status of the client
-cleanse the area with soap and water
The client is in the preicteric phase of hepatitis. Which signs and symptoms should the nurse expect the client to exhibit during this phase? -clay colored stools and jaundice -normal appetite and pruritus -afebrile and left upper quadrant pain -complaints of fatigue and diarrhea
-complaints of fatigue and diarrhea
The nurse is meeting a client post-liver transplantation for the first time and notices a tremor as they shake hands. The client states that this has not happened before. Which action by the nurse is most appropriate? -conduct a thorough assessment, then notify the surgeon of the findings -review today's laboratory work, including liver function studies -assess the client's vital signs, and offer acetaminophen if the client is febrile -perform an assessment of the client's gross and fine motor skills
-conduct a thorough assessment, then notify the surgeon of the findings
A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely allow for hemostasis in the client are: -whole blood and albumin -platelets and packed red blood cells -fresh frozen plasma and whole blood -cryoprecipitate and fresh frozen plasma
-cryoprecipitate and fresh frozen plasma
a client has symptoms of cholecystitis. The nurse anticipates that diagnostic tests will show that which area affected by a stone is causing the client's condition?
-cystic duct
The nurse is caring for a client with chronic hepatitis. Which is the best method to use for determining the degree of early ascites? -inspection of the abdomen for enlargement -bimanual palpation for hepatomegaly -daily measurement of abdominal girth -assessment for peritoneal fluid wave
-daily measurement of abdominal girth
During the posticteric phase of hepatitis the nurse would expect to find what? SATA: -increased ALT and AST levels along with an increased bilirubin level -decreased liver enzymes and bilirubin level -flu like symptoms -resolved jaundice and dark urine
-decreased liver enzymes and bilirubin level -resolved jaundice and dark urine
The nurse admitting a patient with acute pancreatitis correlates this disease process with which etiology? -inflammation secondary to toxic substances -abuse of alcohol -destruction of the pancreas by viruses -digestion of the pancreas by enzymes
-digestion of the pancreas by enzymes
What are the precautions that nurses and hospital staff should follow while handling patient's suffering from hepatitis infections? SATA: -the patient must be in a private room with the door closed -dispose of the needles and syringes used on the patient carefully -wear gloves while handling articles contaminated by urine or feces -always wear a mask, gown, and gloves when entering the patient's room -follow infection control precautions while injecting the patient and avoid getting pricked by the used needle
-dispose of the needles and syringes used on the patient carefully -wear gloves while handling articles contaminated by urine or feces -follow infection control precautions while injecting the patient and avoid getting pricked by the used needle
The nurse is assessing a client 24 hrs following a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate? -clamp the T-tube -irrigate the T-tube -document the findings -notify the health care provider
-document the findings
A patient is postop day 4 from a T-tube placement. Which finding below requires you to notify the physician? -drainage from the T-tube is yellowish green -drainage from the T-tube within the past 24 hrs is 925 mL -blood tinged drainage from the T-tube has decreased -patient reports a decrease in nausea
-drainage from the T-tube within the past 24 hrs is 925 mL
Select all the ways a person can become infected with hepatitis B: -contaminated food/water -during the birth process -IV drug use -undercooked pork or wild game -hemodialysis -sexual intercourse
-during the birth process -IV drug use -hemodialysis -sexual intercourse
A client with hepatitis C is being treated with Ribavirin. What nursing action takes priority? -educating the client on ways to remain compliant with the drug regimen -teaching the client that transient muscle aching is a common side effect -ensuring that the client returns to the clinic each week for follow up care -showing the client how to take and record a radial pulse for 1 minute
-educating the client on ways to remain compliant with the drug regimen
Which laboratory findings does the nurse recognize as potentially causing complications of liver disease? -elevated AST and ALT -elevated prothrombin time (PT) and international normalized ratio (INR) -decreased serum albumin and serum globulin levels -decreased serum alkaline phosphatase and ALT
-elevated prothrombin time (PT) and international normalized ratio (INR)
Which laboratory data would serve to alert you that the client with cirrhosis has advanced disease? -elevated serum globulin levels -elevated serum ammonia levels -elevated serum protein levels -decreased lactate dehydrogenase
-elevated serum ammonia levels
A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? -elevated hemoglobin level -elevated serum bilirubin level -elevated blood urea nitrogen -decreased erythrocyte sedimentation rate
-elevated serum bilirubin level
In the care of a client with acute viral hepatitis, which task should be delegated to the unlicensed assistive personnel? -emptying the bedpan while wearing gloves -playing games or engaging the client in diversional activities -monitoring dietary preferences -reporting signs and symptoms of jaundice
-emptying the bedpan while wearing gloves
A client who is jaundiced and is suspected of having contracted hepatitis B has been admitted to the hospital. Which of the following nursing interventions would be most appropriate for this client? -encourage bedrest during this period -assist the client with ambulation to prevent thrombus formation -place the client on a clear liquid diet to reduce the workload of the liver -medicate the client with PRN prochlorperazine maleate (compazine) to relieve nausea
-encourage bedrest during this period
What activities should a patient with esophageal varices avoid? SATA: -excessive coughing -sleeping on back -drinking juice -alcohol consumption -straining during a bowel movement -vomiting
-excessive coughing -alcohol consumption -straining during a bowel movement -vomiting
When providing mouth care to a patient with late stage cirrhosis, you note a pungent, sweet, musty smell to the breath. This is known as: -metallic hepatico -fetor hepaticus -hepaticoacidosis -asterixis
-fetor hepaticus
Which finding indicates that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective? -increased serum albumin level -decreased indirect bilirubin level -improved alertness and orientation -fewer episodes of bleeding varices
-fewer episodes of bleeding varices
The client with severe liver disease and an ammonia level of 190 mg/dL tries to hit the nurse. After successfully calming the client, what action does the nurse take next? -ensure the client has a low protein diet -give the scheduled Lactulose dose -notify the client's family -place the client in restraints
-give the scheduled Lactulose dose
A patient has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine pancreatic islet cell function. The nurse should anticipate what diagnostic test? -glucose tolerance test -ERCP -pancreatic biopsy -abdominal ultrasonography
-glucose tolerance test
A patient with cirrhosis has 4+ pitting edema of the feet and legs and massive ascites. This data indicates that it is most important for the nurse to monitor the patient's: -temperature -albumin level -hemoglobin level -activity level
-hemoglobin level
while assessing a client, the nurse observes Cullen's sign. What condition does the nurse suspect?
-hemorrhagic pancreatitis
Which types of hepatitis are known to cause acute infections only? SATA: -hepatitis A -hepatitis B -hepatitis C -hepatitis D -hepatitis E
-hepatitis A -hepatitis E
The nurse is caring for a patient with known hepatitis B. A second type of hepatitis is discovered. What type of hepatitis would it be? -hepatitis A -hepatitis C -hepatitis D -hepatitis E
-hepatitis D
A nursing student is listing the types of hepatitis that are transmitted through infected blood and body fluids. Which example listed by the nursing student indicates a need for further instruction? -hepatitis C -hepatitis D -hepatitis E -hepatitis G
-hepatitis E
A client is admitted with Laennec's cirrhosis. What data in the client's past history should you inquire about in taking a current history from this client? -history of gallstones -history of alcohol abuse -history of viral hepatitis -history of heart disease
-history of alcohol abuse
The nurse evaluates the client's most recent laboratory data. Which laboratory finding would be consistent with a diagnosis of acute pancreatitis? -hyperglycemia -leukopenia -thrombocytopenia -hyperkalemia
-hyperglycemia
The physician is performing a paracentesis on a client with cirrhosis. For what potential complication of rapid removal of ascitic fluid should you monitor this client? -hypovolemia -systemic vasoconstriction -increased intra-abdominal pressure -rebound hypertension and fluid retention
-hypovolemia
Which type of shock is exhibited in the patient with pancreatitis? -cardiogenic shock -hypovolemic shock -septic shock -hemorrhagic shock
-hypovolemic shock
A patient with viral hepatitis states their flu-like symptoms have subsided. However, they now have yellowing of the skin and sclera along with dark urine. Based on this finding, this is what phase of hepatitis? -icteric -posticeteric -preicteric -convalescent
-icteric
A client is diagnosed with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? -select foods high in fat -increase intake of fluids, including juices -eat a good supper, when anorexia is not as severe -eat less often, preferably only 3 large meals daily
-increase intake of fluids, including juices
A client just returned to the nursing unit after having a transjugular intrahepatic portal systemic shunt (TIPS) procedure. Which clinical finding does the nurse expect to observe in this client? -decreased LOC -decreased urinary volume -increased blood pressure -increased abdominal girth
-increased blood pressure
Which action performed by a nurse while caring for a patient with cirrhosis puts the patient at an increased risk of complication? -providing electrolyte replacements such as potassium -administering diuretics -increasing amounts of protein in the diet -restricting sodium and fluid intake as ordered
-increasing amounts of protein in the diet
A 25 year old patient was exposed to the hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient? -inform the patient to notify the physician when signs and symptoms of viral hepatitis start to appear -reassure the patient that the chance of acquiring the virus is very low -inform the patient it is very important to obtain the hepatitis A vaccine immediately to prevent infection -inform the patient to promptly go to the local health department to receive immune globulin
-inform the patient to promptly go to the local health department to receive immune globulin
The nurse develops a plan of care for a client with a T-tube. Which nursing intervention should be included? -inspect skin around the T-tube daily for irritation -irrigate the T-tube every 4 hours to maintain patency -maintain client in a supine position while the T-tube is in place -keep the T-tube clamped except during meal times
-inspect skin around the T-tube daily for irritation
The nurse is teaching a group of preschool teachers about hepatitis A. Which is true? SATA: -it can cause chronic infection -it can last up to 8 weeks -it can be spread by blood and body fluids -it can cause mild symptoms, or sometimes the patient may remain asymptomatic -it can cause an elevation in the levels of anti-HAV IgM
-it can last up to 8 weeks -it can cause mild symptoms, or sometimes the patient may remain asymptomatic -it can cause an elevation in the levels of anti-HAV IgM
which symptoms of pancreatic cancer probably prompted the initial visit to the doctor?
-jaundice
The nurse caring for a patient with liver failure notes a change in mental status and elevated ammonia level. Which ordered interventions are most directly related to treating these clinical manifestations? -diuretics -high protein diet -coumadin -lactulose and neomycin
-lactulose and neomycin
Which discharge instruction would be appropriate for a client who has had a laparoscopic cholecystectomy and has sutures covered by a dressing? -avoid showering for 1 week after surgery -return to work within 1 week -leave dressing in place until seeing the surgeon at the postoperative visit -use acetaminophen to control any fever
-leave dressing in place until seeing the surgeon at the postoperative visit
Which of the following symptoms would the nurse anticipate observing in a client with pancreatitis? -hypertension, elevated WBC, and peripheral edema -left upper quadrant abdominal pain, nausea, and vomiting -hypoglycemia, tachycardia, and cyanosis -decreased WBC, clubbing of fingernails, and mid-epigastric discomfort
-left upper quadrant abdominal pain, nausea, and vomiting
A client is hospitalized with hepatitis A. Which of the client's regular medications is contraindicated due to the current illness? -prilosec (omeprazole) -synthroid (levothyroxine) -premarin (conjugated estrogens) -lipitor (atorvastatin)
-lipitor (atorvastatin)
A nurse is providing discharge teaching for a patient who has undergone a laparoscopic cholecystectomy. During the immediate recovery period, the nurse should recommend what foods? -high fiber foods -low-purine, nutrient dense foods -low fat foods high in proteins and carbohydrates -foods that are low residue and low in fat
-low fat foods high in protein and carbohydrates
Combination therapy of Interferon and Ribavirin is being used to treat hepatitis C in a patient with HIV. The nurse will plan to monitor which laboratory value? -blood glucose -lymphocyte count -potassium level -serum creatinine
-lymphocyte count
A client has just undergone a paracentesis. Which nursing intervention is a priority for this client? -monitor urine output -maintain bedrest per protocol -position the client flat in bed -secure the trocar too the abdomen with tape
-maintain bedrest per protocol
A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client food which expected assessment finding? -malaise -dark stools -weight gain -left upper quadrant discomfort
-malaise
A client is admitted to the hospital with a diagnosis of cholecystitis. The client has severe abdominal pain and nausea and has vomited 120 mL. Based on this data, which nursing action would have the highest priority at this time? -manage anxiety -restore fluid loss -manage the pain -replace nutritional loss
-manage the pain
the nurse recognizes that 10% of acute pancreatitis caused by etiologies other than gallstones and alcohol consumption are related to which factor? SATA:
-medications -hypercalcemia -trauma -post-cardiac bypass
When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B? -clients who work with shellfish -men who prefer sex with men -clients traveling to a third world country -clients with elevations in AST and ALT
-men who prefer sex with men
Pain control is an important nursing goal for the client with pancreatitis. Which of the following medications would the nurse plan to administer in this situation? -meperidine hydrochloride (demerol) -cimetidine (tagamet) -morphine sulfate -codeine sulfate
-meperidine hydrochloride (demerol)
The function of the liver includes which of the following? SATA: -metabolism of proteins -production and secretion of bile salts -production of vitamins A,B,D,E,K -filters blood of toxins -production of red blood cells
-metabolism of proteins -production and secretion of bile salts -filters blood of toxins
A client is receiving an infusion of Vasopressin (pitressin) to treat bleeding esophageal varices. Which client complaint indicates to the nurse that a serious adverse effect of the drug may be occurring? -acute nausea and vomiting -a pounding frontal headache -vertigo and syncope -midsternal chest pain
-midsternal chest pain
A client with ascites had a paracentesis. Which post-procedure intervention should the nurse implement? -instruct the client to void immediately -keep the client NPO for 2 hours -place the client on the left side -monitor the client's temperature
-monitor the client's temperature
The nurse should question the administration of which medication in the patient admitted with cholecystitis? -acetaminophen -demerol -ibuprofen -morphine
-morphine
The nurse assesses for which clinical manifestation in the patient with cholecystitis? -murphy's sign -trousseau's sign -cullen's sign -grey turner's sign
-murphy's sign
An infant is brought to the health care clinic for three immunizations at the same time. The nurse knows that hepatitis B, DPT, and Haemophilus influenzae type B immunizations should: -be drawn in the same syringe and given in one injection -be mixed and injected in the same sites -not be mixed and the nurse must give three injections in three sites -be mixed and the nurse must give the injection in three sites
-not be mixed and the nurse must give three injections in three sites
A client returns to the unit after a liver biopsy. The nurse identifies a moderately large amount of bile-colored drainage on the dressing. The client also complains of right upper quadrant pain. The nurse should: -medicate the client for pain as ordered -ensure the client remains in a supine position -monitor the client's vital signs every 15 minutes -notify the practitioner of the client's status immediately
-notify the practitioner of the client's status immediately
The nurse recognizes which as a risk factor for cholecystitis? SATA: -obesity -male -female -african american descent -european descent
-obesity -female -european descent
The nurse recognizes which client as being at greatest risk for the development of carcinoma of the liver? -middle aged client with a history of diabetes mellitus -young adult client with a history of blunt liver trauma -older adult client with a history of cirrhosis -older adult client with malnutrition
-older adult client with a history of cirrhosis
The nurse is assessing a client with mild liver disease. Which assessment does the nurse perform to detect the presence of ascites in this client? -measure lower extremities to assess for edema -inspect and palpate the abdomen for distention -palpate the abdomen in assessing for a fluid wave -percuss the liver while listening for dullness
-palpate the abdomen in assessing for a fluid wave
A patient who is admitted with acute hepatic encephalopathy and ascites receives instructions about appropriate diet. The nurse determines that the teaching has been effective when the patient's choice of foods from the menu includes: -an omelet with cheese and mushrooms and milk -pancakes with butter and honey and orange juice -baked beans with ham, cornbread, potatoes, and coffee -baked chicken with french fries, low-fiber bread, and tea
-pancakes with butter and honey and orange juice
The nurse receives a patient from the operating room after he undergoes a Whipple procedure. The nurse recognizes that this procedure is indicated for the patient who has which disorder? -acute pancreatitis -peritonitis -cholecystitis -pancreatic cancer
-pancreatic cancer
The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the ammonia level is 85 mcg/dL. Which dietary selection does the nurse suggest to the client? -roast pork -cheese omelet -pasta with sauce -tuna fish sandwich
-pasta with sauce
Which medication orders for a patient with chronic hepatitis C infection requires questioning? -Ribavirin 600 mg PO bid -Diphenhydramine 25 mg PO every 4 hrs PRN -pegylated interferon 1.5 mcg/kg PO daily -dramamine 50 mg PO every 6 hrs PRN
-pegylated interferon 1.5 mcg/kg PO daily
what laboratory or diagnostic test should the nurse anticipate being ordered for a client with suspected pancreatic cancer? SATA:
-percutaneous fine needle biopsy -alkaline phosphatase levels -magnetic resonance cholangiopancreatography (MRCP)
The nurse assesses for which finding in a patient with a positive Cullen's sign? -periumbilical bruising -rebound tenderness -RUQ pain with radiation to shoulder -flank bruising
-periumbilical bruising
A client with pancreatitis returns from an endoscopic retrograde cholangiopancreatography (ERCP). Which assessment would be of most concern to the nurse? -reports of upper abdominal pain -reports of a sore throat -retrograde amnesia -poor gag reflex
-poor gag reflex
A client with advanced cirrhosis asks why his abdomen is so swollen. The nurse's best 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 causes a fluid shift into the peritoneal space -decreased peristalsis in the GI tract contributes to gas formation and distension of the bowel -bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid
-portal hypertension and hypoalbuminemia causes a fluid shift into the peritoneal space
A client with end stage cirrhosis is admitted with gastrointestinal bleeding becomes combative and confused. What complication of cirrhosis may this client be experiencing? -ascites -coagulation defects -transient ischemic attack -portal systemic encephalopathy
-portal systemic encephalopathy
A registered nurse is caring for a client following a liver biopsy with the assistance of a student nurse. The RN evaluates that the student understands the postprocedure care when the student nurse: -plans to monitor vital signs every hour -promotes ambulation 1 hr after the procedure -positions the client on the right side -encourages the client to cough and deep breathe immediately following the procedure
-positions the client on the right side
A patient has completed the hepatitis B vaccine series. What blood result below would demonstrate the vaccine series was successful at providing immunity to hepatitis B? -positive IgG -positive HBsAg -positive IgM -positive anti-HBs
-positive anti-HBs
what type of cirrhosis can be caused by acute viral hepatitis B or C infection or drug-induced massive hepatic necrosis
-postnecrotic cirrhosis
In reviewing diagnostic results of a patient with suspected hepatitis, the nurse correlates which result is consistent with hepatitis A? -prolonged prothrombin time -decreased WBC count -presence of anti-HAV IgM -detectable serum HBV DNA
-presence of anti-HAV IgM
A client with acute hepatitis is prescribed Lactulose. The nurse knows that this medication will: -prevent the absorption of ammonia from the bowel -prevent hypoglycemia -remove bilirubin from the blood -mobilize iron stores from the liver
-prevent the absorption of ammonia from the bowel
The pancreas has both exocrine and endocrine functions. Which is an endocrine function of the pancreas? -secretes pancreatic enzymes -produces glucagon -secretes chyme -produces bicarbonate
-produces glucagon
For a client with cirrhosis, what nursing intervention would be most appropriate to control fluid accumulation in the abdominal cavity? -monitoring I&O -providing a low sodium diet -increasing PO fluid intake -weighing the client daily
-providing a low sodium diet
A client is admitted with cirrhosis. The liver of this client is enlarged, and the nurse suspects it is congested with venous blood. Which clinical manifestation would you expect to find considering the origin of cirrhosis in this client? -left upper quadrant pain -pulmonary congestion -jaundice -vomiting
-pulmonary congestion
How does the home care nurse best modify the client's home environment to manage side effects of lactulose? -provide small frequent meals for the client -suggest taking daily potassium supplements -elevates the HOB in high fowler's position -request a bedside commode for the client
-request a bedside commode for the client
A patient who had surgery for gallbladder disease has just returned to the postsurgical unit. The nurse caring for this patient knows to immediately report what assessment finding to the physician? -decreased breath sounds -drainage of bile-colored fluid onto the abdominal dressing -rigidity of the abdomen -acute pain with movement
-rigidity of the abdomen
Which interventions should the nurse provide to a patient with a T-tube? SATA: -routinely flush with preservative saline solution -routinely monitor drainage output -provide T-tube maintenance teaching to the patient -monitor for stool color and consistency -clamp the T-tube when the patient is sleeping
-routinely monitor drainage output -provide T-tube maintenance teaching to the patient -monitor for stool color and consistency
Which interventions should the nurse provide to a patient with a T-tube? SATA: -routinely flush with preservative solution -routinely monitor drainage output -provide T-tube maintenance teaching to the patient -monitor stool for color and consistency -clamp the T-tube when the patient is sleeping
-routinely monitor drainage output -provide T-tube maintenance teaching to the patient -monitor stool for color and consistency
Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B? -advise limiting alcohol intake to 1 drink daily -schedule for liver cancer screening every 6 months -initiate administration of the hepatitis C vaccine series -monitor anti-HBs levels
-schedule for liver cancer screening every 6 months
A patient in the outpatient clinic has positive serologic testing for anti-HCV. Which action by the nurse is appropriate? -schedule the client for HCV genotype testing -teach the patient that the HCV will resolve in 2-4 months -administer immunoglobulin and the HCV vaccine -instruct the patient on self administration of interferon
-schedule the client for HCV genotype testing
what labs should be monitored for a client with pancreatitis?
-serum amylase and lipase
The most specific laboratory result in the patient with acute pancreatitis is an elevation in which laboratory value? -serum bilirubin -serum lipase -serum trypsin -serum lactase
-serum lipase
A female patient expresses concern about becoming pregnant while her partner is on Ribavirin therapy for hepatitis C. What should the nurse advise the patient? -she can plan pregnancy now -she should avoid getting pregnant now -she should not ever get pregnant with this partner -she should avoid any sexual intercourse
-she should avoid getting pregnant now
What is a leading cause of pancreatic cancer? -low fat diet -smoking -history of cancer -heart disease
-smoking
a pt with these S&S are in what stage of hepatic encephalopathy: -slurred speech, tremors, lethargy and euphoria, reversal of day and night sleep patterns, asterixis, impaired writing, impaired decision making, poor coordination
-stage 1
a pt with these S&S are in what stage of hepatic encephalopathy: -increased drowsiness, disorientation, inappropriate behavior, mood swings, agitation, asterixis, fetor hepaticus
-stage 2
A nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep, and has rigid extremities. Based on these findings, the nurse should document what stage of hepatic encephalopathy? -stage 1 -stage 2 -stage 3 -stage 4
-stage 3
a pt with these S&S are in what stage of hepatic encephalopathy: -severe confusion, difficult to awaken, slurred speech, asterixis, increased DTR's, rigid extremities
-stage 3
a pt with these S&S are in what stage of hepatic encephalopathy: -coma, nonresponsive to painful stimuli
-stage 4
The main function of the gallbladder is to: -store bile -produce bile -store fats -produce fats
-store bile
A patient is prescribed Peginterferon alpha-2a. The nurse will prepare to administer this medication what route? -oral -intramuscular -subcutaneous -intravenous
-subcutaneous
Which of the following health promotion activities would be appropriate for the nurse to suggest that the client with cirrhosis add to the daily routine at home? -supplement the diet with daily multivitamins -limit daily alcohol intake -take a sleeping pill at bedtime -limit contact with other people whenever possible
-supplement the diet with daily multivitamins
A client with jaundice has pruritus and states that he has areas of irritation from scratching. What measures can the nurse discuss to prevent skin breakdown? SATA: -avoid lotions containing calamine -take baking soda baths -keep nails short and clean -rub with knuckles instead of nails -massage skin with alcohol -increase sodium intake in diet
-take baking soda baths -keep nails short and clean -rub with knuckles instead of nails
Which factor should the nurse anticipate finding when reviewing the medical history of a client diagnosed with acute pancreatitis? SATA: -autoimmune disorder -taking acetaminophen -gallstones -nutritional deficiencies -viral infection
-taking acetaminophen -gallstones -viral infection
A client with chronic hepatitis C has been receiving interferon alpha 2a (roferon-A) injections for the last month. Which information gathered during a visit in the home is most important to communicate to the physician? -the client has chronic nausea and vomiting -the client is giving the medication by the IM route to the lateral thigh -the client has a temp of 99.7 -the client complains of chronic fatigue, muscle aches, and anorexia
-the client has chronic nausea and vomiting
You obtain the following assessment data for a client with a history of liver transplant who is receiving cyclosporine, prednisone, and mycophenolate to suppress immune function. What information found will be of most concern? -the client's gums appear very pink and swollen -the client's blood glucose is 162 mg/dL -the client has non-tender swelling above the clavicle -the client has +1 pitting edema in the feet and ankles
-the client has non-tender swelling above the clavicle
The nursing team consists of an RN, LPN, and a nursing assistant. Which client should be assigned to the RN? -the client who is taking Lactulose and has diarrhea -the client with hepatitis C who requires a dressing change -the client with end-stage cirrhosis who needs teaching about a low-sodium diet -the obtunded client with alcoholic encephalopathy who needs a blood draw
-the client with end-stage cirrhosis who needs teaching about a low-sodium diet
Which response by the nurse best explains the purpose of Ranitidine (zantac) for a patient with bleeding esophageal varices? -the medication will reduce the risk for aspiration -the medication will inhibit development of gastric ulcers -the medication will prevent irritation of enlarged veins -the medication will decrease nausea and improve appetite
-the medication will prevent irritation of enlarged veins
A 36 year old patient's lab work shows anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as? -the patient has an active infection of hepatitis A -the patient has recovered from a previous hepatitis A infection and is now immune to it -the patient is in the preicteric phase of viral hepatitis -the patient is in the icteric phase of viral hepatitis
-the patient has recovered from a previous hepatitis A infection and is now immune to it
When taking a health history for a new patient, which information given by the patient would indicate that screening for hepatitis C is appropriate? -the patient had a blood transfusion after surgery in 1998 -the patient reports a one time use of IV drugs 20 years ago -the patient eats frequent meals in fast-food restaurants -the patient recently traveled to an underdeveloped country
-the patient reports a one time use of IV drugs 20 years ago
A patient is diagnosed with hepatitis D. What statement is true about this type of viral hepatitis? SATA: -the patient will also have the hepatitis B virus -hepatitis D is most common in southern and eastern europe, mediterranean, and middle east -prevention of hepatitis D included handwashing and the hepatitis D vaccine -hepatitis D is most commonly transmitted via the fecal-oral route
-the patient will also have the hepatitis B virus -hepatitis D is most common in southern and eastern europe, mediterranean, and middle east
When admitting a patient with cirrhosis, the nurse assesses for which condition related to splenomegaly as a possible complication of the disease? -thrombocytopenia -bleeding esophageal varices -hepatorenal syndrome -portal hypertensive gastropathy
-thrombocytopenia
which factor should the nurse providing care for a client with liver cancer anticipate finding on assessment? SATA:
-unintentional weight loss -hepatomegaly -white chalky stools
A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan, the nurse should include instructions to: -avoid alcohol for the first 3 weeks -use a condom during sexual intercourse -have family members get an injection of immunoglobulin -follow a low protein, moderate carbohydrate, moderate fat diet
-use a condom during sexual intercourse
Which of the following is not a specific element of hepatitis C? -vaccine available -may be transmitted with sexual contact -inflammation of the liver -lifetime carrier
-vaccine available
A client is diagnosed with type A hepatitis. What special precautions should the nurse take when caring for this client? -put on a mask and gown before entering the client's room -wear gloves and a gown when removing the client's bedpan -prevent the droplet spread of the organism -use caution when brining food to the client
-wear gloves and a gown when removing the client's bedpan
A portocaval shunt is considered for a patient with cirrhosis following an episode of bleeding esophageal varices. The nurse plans to teach the patient that this procedure: -is likely to improve the patient's life expectancy -will increase the risk of hepatic encephalopathy -will help to decrease the incidence of peritonitis -is a first line therapy for portal hypertension
-will increase the risk of hepatic encephalopathy
Tony was diagnosed with hepatitis A. The information from the health history that is most likely linked to hepatitis A is: -exposed with arsenic compounds at work -working as a local plumber -working at a hemodialysis clinic -dish washer in restaurants
-working as a local plumber
Which of the following symptoms during the icteric phase of viral hepatitis should the nurse expect the client to inhibit? -watery stool -yellow sclera -tarry stool -shortness of breath
-yellow sclera
A patient with hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? SATA: -none because this bilirubin level is normal -yellowing of the skin and sclera -clay colored stools -bluish discoloration on the flanks of the abdomen -dark urine -mental status changes
-yellowing of the skin and sclera -clay colored stools -dark urine
normal direct (conjugated) bilirubin
0-0.3 mg/dL
normal indirect (unconjugated) bilirubin
0-1 mg/dL
normal ammonia
0-32 mmol/L
normal AST
0-37 IU/L
normal ALT
0-40 IU/L
normal GGT
0-51 IU/L
normal total serum bilirubin
0.1-1.2 mg/dL
normal albumin
3.5-5.5 g/dL
normal serum alkaline phosphatase
30-120 IU/L
normal prothrombin time (PT)
9.6-12.5 seconds
