Hepatic/Biliary Disorders

A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations? a) Portal hypertension b) Hepatitis C c) Hepatic encephalopathy d) Esophageal varices

Hepatic encephalopathy The earliest symptoms of hepatic encephalopathy include minor mental changes and motor disturbances. The client appears slightly confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and have restlessness and insomnia at night. As hepatic encephalopathy progresses, the client may become difficult to awaken and completely disoriented with respect to time and place. With further progression, the client lapses into frank coma and may have seizures. Simple tasks, such as handwriting, become difficult.

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? a) Hepatitis A is frequently spread by sexual contact. b) Hepatitis B is transmitted primarily by the oral-fecal route. c) Infection with hepatitis G is similar to hepatitis A. d) Hepatitis C increases a person's risk for liver cancer.

Hepatitis C increases a person's risk for liver cancer. Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C. (less)

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a) Maintaining adequate nutritional status b) Relieving abdominal pain c) Preventing fluid volume overload d) Teaching about the disease and its treatment

Relieving Abd pain The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after onset of the illness. Therefore, relieving abdominal pain is the nurse's primary goal. Because acute pancreatitis causes nausea and vomiting, the nurse should try to prevent fluid volume deficit, not overload. The nurse can't help the client achieve adequate nutrition or understand the disease and its treatment until the client is comfortable and no longer in pain. (less)

The nurse is educating a patient who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the teaching? a) Decrease the amount of protein in the diet. b) Increase the amount of magnesium in the diet. c) Decrease the amount of fats in the diet. d) Increase the amount of potassium in the diet.

a) Decrease the amount of protein in the diet. Patients with hepatic encephalopathy and their families are advised about foods that are high in protein (e.g., meat, eggs), which may need to be limited in the diet for the short term to reduce production of ammonia. (less)

What is the most appropriate nursing diagnosis for the client with acute pancreatitis? a) Deficient fluid volume b) Decreased cardiac output c) Excess fluid volume d) Ineffective gastrointestinal tissue perfusion

a) Deficient fluid volume Clients with acute pancreatitis often experience deficient fluid volume, which can lead to hypovolemic shock. Vomiting, hemorrhage (in hemorrhagic pancreatitis), and plasma leaking into the peritoneal cavity may cause the volume deficit. Hypovolemic shock will cause a decrease in cardiac output. Gastrointestinal tissue perfusion will be ineffective if hypovolemic shock occurs, but this wouldn't be the primary nursing diagnosis. (less)

A patient has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions? a) Hepatic encephalopathy b) Cirrhosis c) Asterixis d) Portal hypertension

a) Hepatic encephalopathy Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction. (less)

Which of the following would be included as a postoperative intervention for the patient undergoing a laparoscopic cholecystectomy? a) Observe color of sclera b) Low-carbohydrate, low-protein diet immediately after surgery c) NPO status postop for 2 days d) Semi-Fowler's position

a) Observe color of sclera The nurse should be particularly observant of the color of the sclera. After recovery from anesthesia, the patient is placed in the low Fowler's position. Water and other fluids may be administered within hours after laparoscopic procedures. A soft diet is started after bowel sounds return. (less)

To reduce risk of injury for a patient with liver disease, what initial measure can the nurse implement? a) Pad the side rails on the bed b) Raise all four side rails on the bed c) Apply soft wrist restraints d) Prevent visitors, so as not to agitate the patient

a) Pad the side rails on the bed Padding the side rails can reduce injury if the patient becomes agitated or restless. Restraints would not be an initial measure to implement. Four side rails are considered a restraint and this would not be an initial measure to implement. Family and friends most generally assist in calming a patient. (less)

Which of the following is clinical manifestation of cholelithiasis? a) Epigastric distress prior to a meal b) Clay-colored stools c) Upper left quadrant abdominal pain d) Nonpalpable abdominal mass

b) Clay-colored stools The patient with gallstones has clay-colored stools, and excruciating upper right quadrant pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored. The patient develops a fever and may have a palpable abdominal mass.

A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? a) Pleural effusion b) Edema and inflammation c) Sepsis d) Disseminated intravascular coagulopathy

b) Edema and inflammation Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas. Minimal organ dysfunction is present, and return to normal function usually occurs within 6 months. (less)

From the following profiles of clients, which client would be most likely to undergo the diagnostic test of cholecystography? a) Sandra, suspected of having lesions in the liver b) Mark, suspected of having stones in the gallbladder c) Andrew, suspected of having esophageal abnormalities d) Steven, suspected of having a tumor in the colon

b) Mark, suspected of having stones in the gallbladder Cholecystography will be most appropriate for Mark because the test is used to detect stones in the gallbladder. Most likely, Andrew would require barium swallow test to detect any abnormalities in the esophagus. Steven would need a barium enema for to identify a tumor in the colon. Sandra would undergo a radionuclide image test for her lesions in the liver. (less)

Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following? a) Alcohol b) Calcium c) Ammonia d) Bicarbonate

c) Ammonia Lactulose (Cephulac) is administered to reduce serum ammonia levels. Cephulac does not influence calcium, bicarbonate, or alcohol levels.

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes melitus. Which of the following explains the cause of this secondary diabetes? a) Renal failure b) Inability for the liver to reabsorb serum glucose c) Dysfunction of the pancreatic islet cells d) Ingestion of foods high in sugar

c) Dysfunction of the pancreatic islet cells Diabetes mellitus resulting from dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents. The hazard of severe hypoglycemia with alcohol consumption is stressed to the client and family. When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. A standard treatment with pancreatitis is to make the client NPO. The dysfunction is related to the pancreas, not the liver. (less)

A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system? a) Administer enteral or parenteral nutrition. b) Withhold oral feedings. c) Maintain the client in a semi-Fowler's position. d) Carry out wound care as prescribed.

c) Maintain the client in a semi-Fowler's position. The nurse maintains the client in the semi-Fowler's position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. Respiratory distress and hypoxia are common, and the client may develop diffuse pulmonary infiltrates, dyspnea, tachypnea, and abnormal blood gas values. The client who has undergone surgery may have multiple drains or an open surgical incision and is at risk for skin breakdown and infection. Oral food or fluid intake is not permitted; therefore, enteral or parenteral feedings may be prescribed. (less)

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: a) appendicitis. b) cholelithiasis. c) cirrhosis. d) peptic ulcer disease.

c) cirrhosis. Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal. (less)

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find? a) Decreased white blood cell count b) Increased serum calcium levels c) Decreased liver enzyme levels d) Elevated urine amylase levels

d) Elevated urine amylase levels Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis. If the common bile duct is obstructed, the bilirubin level is above normal. Blood glucose levels and white blood cell counts can be elevated. Serum electrolyte levels (calcium, potassium, and magnesium) are low. (less)

Which of the following would be the least important assessment in a patient diagnosed with ascites? a) Weight b) Palpation of abdomen for a fluid shift c) Measurement of abdominal girth d) Foul-smelling breath

d) Foul-smelling breath Foul-smelling breath would not be considered an important assessment for this patient. Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the patient diagnosed with ascites.

Which of the following indicates an overdose of lactulose? a) Hypoactive bowel sounds b) Fecal impaction c) Constipation d) Watery diarrhea

d) Watery diarrhea The patient receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? a) "You must have the second one in 1 year and the third the following year." b) "You must have the second one in 2 weeks and the third in 1 month." c) "You must have the second one in 6 months and the third in 1 year." d) "You must have the second one in 1 month and the third in 6 months."

"You must have the second one in 1 month and the third in 6 months." Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.

A patient with end-stage liver disease who is scheduled to undergo a liver transplant tells the nurse, "I am worried that my body will reject the liver." Which of the following statements is the nurse's best response to the patient? a) "You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs." b) "The problem of rejection is not as common in liver transplants as in other organ transplants." c) "You would not be scheduled for a transplant if there was a concern about rejection." d) "It is easier to get a good tissue match with liver transplants than with other types of transplants."

"You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs." Rejection is a primary concern. A transplanted liver is perceived by the immune system as a foreign antigen. This triggers an immune response, leading to the activation of T lymphocytes that attack and destroy the transplanted liver. Immunosuppressive agents are used as long-term therapy to prevent this response and rejection of the transplanted liver. These agents inhibit the activation of immunocompetent T lymphocytes to prevent the production of effector T cells. Although the 1- and 5-year survival rates have increased dramatically with the use of new immunosuppressive therapies, these advances are not without major side effects. The other statements are inaccurate or will not decrease the patient's anxiety.

A patient with acute pancreatitis has been started on total parenteral nutrition (TPN). Following the administration of the TPN, which of the following should the nurse plan to monitor? a) Complaints of nausea and vomiting b) Measure the abdominal girth every shift c) Auscultate the abdomen for bowel sounds every 4 hours d) Blood glucose levels every 4 to 6 hours

Blood glucose levels every 4 to 6 hours Enteral or parenteral nutrition may be prescribed. In addition to administering enteral or parenteral nutrition, the nurse monitors serum glucose levels every 4 to 6 hours.

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 liver biopsy A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure. It can be performed in the radiology department with ultrasound or CT to identify appropriate placement of the trocar or biopsy needle. A prothrombin time and platelet count will assist with determining if the client is at increased risk for bleeding.

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a) Anxiety related to unknown outcome of hospitalization b) Deficient knowledge related to prevention of disease recurrence c) Imbalanced nutrition: Less than body requirements related to biliary inflammation d) Acute pain related to biliary spasms

Acute pain related to biliary spasms The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns. (less)

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a) Providing mouth care b) Maintaining nothing-by-mouth (NPO) status c) Placing the client in a semi-Fowler's position d) Administering morphine I.V. as ordered

Administering morphine I.V. as ordered The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

Which of the following conditions in a patient with pancreatitis makes it necessary for the nurse to check fluid intake and output, hourly urine output, and monitor electrolyte levels? a) Frequent vomiting leading to loss of fluid volume b) Acetone in the urine c) High glucose levels in the blood d) Dry mouth, which makes the patient thirsty

Frequent vomiting leading to loss of fluid volume Fluid and electrolyte disturbances are common complications because of nausea, vomiting, movement of fluid from the vascular compartment to the peritoneal cavity, diaphoresis, fever, and the use of gastric suction. The nurse assesses the patient's fluid and electrolyte status by noting skin turgor and moistness of mucous membranes. The nurse weighs the patient daily and carefully measures fluid intake and output, including urine output, nasogastric secretions, and diarrhea.

A homeless client at the neighborhood clinic has a lengthy history of alcohol addiction and is being seen for jaundice. Which of the following would the appearance of jaundice most likely indicate? a) Gallbladder disease b) Glucose underproduction c) Liver disorder d) Bile overproduction

Liver Disorder Jaundice is a sign of disease, but it is not itself a unique disease. Jaundice accompanies many diseases that directly or indirectly affect the liver and is probably the most common sign of a liver disorder. (less)

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? a) Encouraging frequent visits from family and friends b) Positioning the client on the side with the knees flexed c) Administering frequent oral feedings d) Administering an analgesic once per shift, as ordered, to prevent drug addiction

Positioning the client on the side with the knees flexed The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and ordered, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: a) Common bile duct b) Cystic duct c) Duodenum d) Gallbladder

The gallbladder functions as a storage depot for bile.

Total parental nutrition (TPN) should be used cautiously in patients with pancreatitis due to which of the following? a) They cannot tolerate high-glucose concentration. b) They are at risk for gallbladder contraction. c) They can digest high-fat foods. d) They are at risk for hepatic encephalopathy.

They cannot tolerate high-glucose concentration. Total parental nutrition (TPN) is used carefully in patients with pancreatitis because some patients cannot tolerate a high-glucose concentration, even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, while intake of high protein increases risk for hepatic encephalopathy in patients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function? a) 70 mg/dL b) 50 mg/dL c) 30 mg/dL d) 90 mg/dL

c) 30 mg/dL Hyperinsulinism is caused by overproduction of insulin by the pancreatic islets. Occasionally, tumors of nonpancreatic origin produce an insulinlike material that can cause severe hypoglycemia and may be responsible for seizures coinciding with blood glucose levels that are too low to sustain normal brain function (i.e., lower than 30 mg/dL [1.6 mmol/L])

Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices? a) Spironolactone (Aldactone) b) Cimetidine (Tagamet) c) Vasopressin (Pitressin) d) Nitroglycerin

Vasopressin (Pitressin) Vasopressin may be the initial therapy for esophageal varices, because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Aldactone and Tagamet do not decrease portal hypertension. (less)

An 87-year-old client is in the ICU where you practice nursing. He was admitted for critical care due to his esophageal varices and his precarious physical condition. Which of the following could result in causing his varices to hemorrhage? a) All options are correct. b) Little protective tissue to protect fragile veins c) Rough food d) Chemical irritation

a) All options are correct. Esophageal varices overfill as a result of portal hypertension. They are especially vulnerable to bleeding because they lie superficially in the mucosa, contain little protective elastic tissue, and are easily traumatized by rough food or chemical irritation. Esophageal varices are especially vulnerable to bleeding because they lie superficially in the mucosa, contain little protective elastic tissue, and are easily traumatized by rough food or chemical irritation. (less)

When caring for a patient with cirrhosis, which of the following symptoms should the nurse report immediately? a) Anorexia and dyspepsia b) Diarrhea or constipation c) Change in mental status d) Fatigue and weight loss

c) Change in mental status When caring for a patient with cirrhosis, the nurse should report any change in mental status immediately because they indicate secondary complications. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis. (less)

Several clinical manifestations are associated with a tumor of the head of the pancreas. Choose all that apply. a) Amber-colored urine b) Dark-colored stools c) Jaundice d) Clay-colored stools e) Dark urine

• Jaundice • Clay-colored stools • Dark urine Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. The obstructed flow of bile produces jaundice, clay-colored stools, and dark urine. Malabsorption of nutrients and fat-soluble vitamins may result if the tumor obstructs the entry of bile to the gastrointestinal tract. Abdominal discomfort or pain and pruritus may be noted, along with anorexia, weight loss, and malaise. If these signs and symptoms are present, cancer of the head of the pancreas is suspected.