Lewis Chapter 43 Liver, Biliary, and Pancreas Problems
45. In reviewing the medical record for a patient admitted with acute pancreatitis, the nurse sees that the patient has a positive Cullen's sign. Indicate the area in the accompanying figure where the nurse will assess for this change. a. 1 b. 2 c. 3 d. 4
ANS: C The area around the umbilicus should be indicated. Cullen's sign consists of ecchymosis around the umbilicus. Cullen's sign occurs because of seepage of bloody exudates from the inflamed pancreas and indicates severe acute pancreatitis.
17. How should the nurse prepare a patient with ascites for paracentesis? a. Place the patient on NPO status. b. Assist the patient to lie flat in bed. c. Ask the patient to empty the bladder. d. Position the patient on the right side.
C
16. Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective? a. Increased serum albumin level b. Decreased indirect bilirubin level c. Improved alertness and orientation d. Fewer episodes of bleeding varices
D
28. A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.
D
29. Which assessment finding is of most concern for a patient with acute pancreatitis? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass
D
12. Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis? a. The patient is alert and oriented. b. The patient denies nausea or anorexia. c. The patient's bilirubin level decreases. d. The patient has at least one stool daily.
A
19. Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis? a. Lipase b. Calcium c. Bilirubin d. Potassium
A
23. The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement? a. "I can take a shower and walk around the house tomorrow." b. "I need to limit my activities and not return to work for 4 weeks." c. "I can expect yellowish drainage from the incision for a few days." d. "I will follow a low-fat diet for life because I do not have a gallbladder."
A
3. A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate? a. Schedule the patient for HCV genotype testing. b. Administer the HCV vaccine and immune globulin. c. Teach the patient about ribavirin (Rebetol) treatment. d. Explain that the infection will resolve over a few months.
A
42. A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider? a. Asterixis and lethargy b. Jaundiced sclera and skin c. Elevated total bilirubin level d. Liver 3 cm below costal margin
A
5. The nurse administering -interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for: a. leukopenia. b. hypokalemia. c. polycythemia. d. hypoglycemia.
A
1. After an unimmunized person is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take? Select all that apply. a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. c. Teach about alpha-interferon therapy. d. give hepatitis B immune globulin e. Explain options for oral antiviral therapy.
ANS: A, B, D The recommendations for hepatitis B exposure include both vaccination and immune globulin administration. In addition, baseline testing for hepatitis B antibodies will be needed. Interferon and oral antivirals are not used for hepatitis B prophylaxis.
11. Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? a. Request that the patient stand on one foot. b. Ask the patient to extend both arms forward. c. Request that the patient walk with eyes closed. d. Ask the patient to perform the Valsalva maneuver.
B
13. A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care? a. Instruct the patient to cough every hour. b. Monitor the patient for shortness of breath. c. Verify the position of the balloon every 4 hours. d. Deflate the gastric balloon if the patient reports nausea.
B
14. What is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices? a. Bilirubin levels b. Ammonia levels c. Potassium levels d. Prothrombin time
B
21. What risk factor will the nurse specifically ask about when a patient is being admitted with acute pancreatitis? a. Diabetes b. Alcohol use c. High-protein diet d. Cigarette smoking
B
22. What should the nurse teach a patient with chronic pancreatitis is the time to take the prescribed pancrelipase (Viokase)? a. Bedtime b. Mealtime c. When nauseated d. For abdominal pain
B
24. The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern? a. The patient reports right upper-quadrant pain with palpation. b. The patient's hands flap back and forth when the arms are extended. c. The patient has ascites and a 2-kg weight gain from the previous day. d. The patient's abdominal skin has multiple spider-shaped blood vessels.
B
33. Which goal has the highest priority in the plan of care for a 26-yr-old patient who was admitted with viral hepatitis, has severe anorexia and fatigue, and is homeless? a. Increase activity level. b. Maintain adequate nutrition. c. Establish a stable environment. d. Identify source of hepatitis exposure.
B
35. The nurse is planning care for a patient with acute severe pancreatitis. What is the highest priority patient outcome? a. Having fluid and electrolyte balance b. Maintaining normal respiratory function c. Expressing satisfaction with pain control d. Developing no ongoing pancreatic disease
B
37. Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis? a. The patient's urine is bright yellow. b. The patient's stools are tan colored. c. The patient reports chronic heartburn. d. The patient has increased pain after eating.
B
39. For a patient who has cirrhosis, which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)? a. Assessing the patient for jaundice b. Providing oral hygiene after a meal c. Palpating the abdomen for distention d. Teaching the patient the prescribed diet
B
4. What topic should the nurse plan to teach the patient diagnosed with acute hepatitis B? a. Administering alpha-interferon b. Measures for improving appetite c. side effects of nucleotide analogs d. Ways to increase activity and exercise
B
40. Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B? a. Advise limiting alcohol intake to 1 drink daily. b. Schedule for liver cancer screening every 6 months. c. Initiate administration of the hepatitis C vaccine series. d. Monitor anti-hepatitis B surface antigen (anti-HBs) levels.
B
6. Which information from a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? a. The patient had a blood transfusion in 2005. b. The patient used IV drugs about 20 years ago. c. The patient frequently eats in fast-food restaurants. d. The patient traveled to a country with poor sanitation.
B
9. Which topic is most important to include in teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis? a. Taking lactulose b. Avoiding all alcohol use c. Maintaining good nutrition d. Using vitamin B supplements
B
2. The nurse evaluates that administration of hepatitis B vaccine to a healthy patient has been effective when the patient's blood specimen reveals: a. HBsAg. b. anti-HBs. c. anti-HBc IgG. d. anti-HBc IgM.
B The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV.
18. Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago? a. Dry palpebral and oral mucosa b. Crackles at bilateral lung bases c. Temperature 100.8° F (38.2° C) d. No bowel movement for 4 days
C
20. Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Muscle twitching and finger numbness d. Upper abdominal tenderness and guarding
C
25. A patient who has cirrhosis and esophageal varices is being treated with propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective? a. The patient reports no chest pain. b. Blood pressure is 130/80 mm Hg. c. Stools test negative for occult blood. d. The apical pulse rate is 68 beats/min.
C
26. Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient who was admitted with bleeding esophageal varices? a. The medication will reduce the risk for aspiration. b. The medication will inhibit development of gastric ulcers. c. The medication will prevent irritation of the enlarged veins. d. The medication will decrease nausea and improve the appetite.
C
27. When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level in the chart. d. Notify the health care provider immediately.
C
32. During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first? a. A 58-yr-old patient who has compensated cirrhosis and reports anorexia b. A 40-yr-old patient with chronic pancreatitis who has gnawing abdominal pain c. A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C) d. A 36-yr-old patient recovering from a laparoscopic cholecystectomy who has severe shoulder pain
C
34. Which action should the nurse in the emergency department take first for a new patient who is vomiting blood? a. Insert a large-gauge IV catheter. b. Draw blood for coagulation studies. c. Check blood pressure and heart rate. d. Place the patient in the supine position.
C
36. The nurse is caring for a patient with pancreatic cancer. Which nursing action is the highest priority? a. Offer psychologic support for depression. b. Offer high-calorie, high-protein dietary choices. c. Administer prescribed opioids to relieve pain as needed. d. Teach about the need to avoid scratching any pruritic areas.
C
38. A patient had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to: a. perform leg exercises hourly while awake. b. ambulate the evening of the operative day. c. turn, cough, and deep breathe every 2 hours. d. choose preferred low-fat foods from the menu.
C
41. A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical examination? a. Start the hepatitis B immunization series. b. Teach the patient about hepatitis A immune globulin. c. Ask whether the patient has been screened for hepatitis C. d. Test for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM).
C
43. A 36-yr-old female patient is receiving treatment for chronic hepatitis B with pegylated interferon (Pegasys). Which finding is important to communicate to the health care provider to suggest a change in therapy? a. Nausea and anorexia b. Weight loss of 2 lb (1 kg) c. Positive urine pregnancy test d. Hemoglobin level of 10.4 g/dL
C
7. A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies, but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is appropriate? a. "Have you taken corticosteroids?" b. "Do you have a history of IV drug use?" c. "Do you use any over-the-counter drugs?" d. "Have you recently traveled to another country?"
C
1. A young adult contracts hepatitis from contaminated food. What should the nurse expect serologic testing to reveal during the acute (icteric) phase of the patient's illness? a. Antibody to hepatitis D (anti-HDV) b. Hepatitis B surface antigen (HBsAg) c. Anti-hepatitis A virus immunoglobulin G (anti-HAV IgG) d. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)
D
10. A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take? a. Withhold both drugs. b. Administer both drugs. c. Administer the furosemide. d. Administer the spironolactone.
D
15. A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care? a. Restrict daily dietary protein intake. b. Reposition the patient every 4 hours. c. Perform passive range of motion twice daily. d. Place the patient on a pressure-relief mattress.
D
30. Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)? a. Teach symptoms of variceal bleeding. b. Draw blood for hepatitis serology testing. c. Discuss the need to increase caloric intake. d. Review the patient's current medication list.
D
31. A patient with chronic hepatitis B infection has several medications prescribed. Which medication order requires clarification with the health care provider before administration? a. Tenofovir (Viread) orally once daily b. Adefovir (Hepsera) orally once daily c. Entecarvir (Baraclude) orally once daily d. Pegylated alpha-interferon (Pegasys) orally once daily
D
44. A nurse is considering which patient to admit to the same room as a patient who is hospitalized with acute rejection 3 weeks after a liver transplant. Which patient would be the best choice? a. Patient who is receiving chemotherapy for liver cancer b. Patient who is receiving treatment for acute hepatitis C c. Patient who has a wound infection after cholecystectomy d. Patient who requires pain management for chronic pancreatitis
D
8. Which focused data should the nurse assess after identifying 4+ pitting edema on a patient who has cirrhosis? a. Hemoglobin b. Temperature c. Activity level d. Albumin level
D
