N103 CH 45 (EOC,ATI,Workbook)

A nurse is collecting data from a client who has pancreatitis. Which of the following actions should the nurse take to check for the presence of Cullen's sign?

inspect the skin around the umbilicus

a nurse is collecting data from a client who has acute pancreatitis. Which of the following findings is the priority to report

hand spasms when blood pressure is checked

The nurse is caring for a patient with cholecystitis associated with cholelithiasis. WHich statement by the nurse is most accurate when answering patient questions?

" A heavy meal with a high fat content may precipitate the signs and symptoms of the disease"

The nurse is caring for a patient with hepatic encephalopathy. While assessing the patient, the nurse notes rapid, irregular flexion and extension(flapping) of the wrist when the nurse requests that the patient stretch out the arm and hyperextend the wrist with fingers separated. How should the nurse document this finding?

"Patient demonstrates the presence of asterixis"

The student nurse asks the nurse why a patient with advanced cirrhosis has an abdomen that is so swollen. Which response by the nurse is correct?

"Portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space"

The healthcare provider orders an intramuscular immune serum globulin for hospital employee who was exposed to hepatitis A a dosage of 0.02 ml/kg of body weight is ordered the employee weighs 155 lbs how many ml should the nurse draw up

1.4 ml

A patient is scheduled for surgery for a common bile duct exploration. The nurse would expect the patient to return from surgery with which device in place?

A T-tube connected to gravity drainage.

Cirrhosis

A chronic degenerative disease of the liver in which lobes become covered with fibrous tissue, the parenchyma degenerates, and the lobules are infiltrated with fat. NI: Check Vital every 4 hours, moniter for GI bleeding, fluid status. complication can be hepatic encephalopathy- brain damage caused by liver disease. Pt Teaching: stop drinking alcohol S/S Early Stage:firmness over the liver, generalized weakness, malaise, vague flu-like symptoms Later Stages are: Upset Stomach, ascites, jaundice, Malaise, Spider telangiectasis

esophageal varacies

A complex of longitudinal tortuous veins at the lower end of the esophagus Enlarge and become endometriosis

The patient has symptoms of hepatic encephalopathy in the healthcare provider wants to be called about laboratory results which laboratory result should the nurse seek out to validate the suspected finition

Ammonia level

If a patient is scheduled for an ultrasound of the pancreas, which two situations would cause the examinaton to be postponed?

Abdomen distended with gas, recent barium enema examinaton.

T-tube

Biliary drainage tube

Cholangiomas

Biliary duct carcinomas

A nurse reviewing discharge instructions with a client who is postoperative following open cholecystectomy with T-tube placement. Which of the following instructions should the nurse include in the teaching? (Select all that apply)

Clamp T-tube for 1 hr before and after meals Expect brown-green drainage from the tube

While caring for a patient with hepatitis A, the nurse expects the stools of the patient to appear what color?

Clay-colored (Acholic)

The nurse is preparing a presentation on hepatitis types, B,C,D, and G. What should the nurse include in the presentation regarding the most common methods of becoming infectec with the disease? (select all that apply)

Contaminated needles and instruments Direct contact with body fluids from infected people, such as through breast milk and sexual contact

Sphincter of Oddi

Controls the flow of pancreatic juices and bile into the duodenum

Hepatitis g

Detected in blood samples and Europe Asia and Australia Transmission occurs when tainted injectable drugs are used tainted blood organs or tissues are receipt or unsafe methods are used for tattooing or body piercing

While discharging a patient following a laparoscopic cholecystectomy the patient reports mild shoulder pain. The nurse is aware that the pain is likely caused by which factor?

Diaphragmatic irritation secondary to residual carbon dioxide

A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding?

Direct bilirubin 2.1 mg/dL

A nurse is caring for a client who has cirrhosis. Which of the following medications should the nurse expect to administer to this client? ( select all that apply)

Diurectic Beta-blocking agent Lactulose

Which behavior places the patient at greatest risk to contract hepatitis e

Drinking water from a questionable source

elevated ammonia level

Elevated ammonia levels suggest liver dysfunction as the cause of the signs and symptoms Normal ammonia Tess value is 10 to 80mcg/dL nursing intervention include to notify the lab of any antibiotics the patient is currently taking such as neomycin can cause a decrease ammonia level.

When caring for a patient with acute pancreatitis which laboratory finding is the best indicator of the disorder

Elevated lipase

A nurse is collecting data from a newly admitted client who has pancreatitis. Which of the following findings should the nurse expect?

Epigastric pain radiating to the left shoulder

the nurse is providing teaching to a patient scheduled to undergo a needle liver biopsy during the examination the patient should be advised to.

Exhale and not breathe as a needle is inserted

The nurse is assessing a newly admitted patient. Which findings are most indicative of liver abscess?

Fever accompanied by chills, abdominal pain and tenderness in the right upper quadrant.

The patient had a hepatobiliary iminodiacetic acid HIDA scan what instructions should the nurse give to the UAP who is assisting the patient with hygiene

Give care as usual there are no special considerations

T-tube was inserted during a cholecystectomy what does the nurse expect to observe when assessing the patient

Greenish yellow drainage from the tube

asterixis

Hand-flapping tremor seen in hepatic encephalopathy pt stretches arm out an arm and hyperextends the wrist with the fingers seperated,relaxed and extended.

HIDA scan

Hepatobiliary iminodiacetic acetic acid scan

The nurse is talking to a patient who had an outpatient oral cholecystogram with a poor visualization of the biliary tree what question would the nurse ask to determine if the patient was compliant with the preparation for the test

How many dye tablets did you take on the evening before the examination

A nurse is reinforcing nutrition teaching with a client who has pancreatitis. Which of the following statements by the client indicates understanding(Select all that apply.)

I plan to eat small frequent meals I will eat easy to digest foods with limited spice I will use skim milk when cooking

The nurse is instructing the UAP about assisting several patients with morning hygiene which patient needs to use a soft toothbrush with very gentle brushing action

In later stage of cirrhosis of the liver

Paracentesis

In which fluid is removed from the abdominal cavity by either gravity or vacuum, provides temporary relief from ascites. NI: Pt should urinate b4 procedure to prevent bladder puncture. Pt should sit on side of bed/be placed in high Fowler's position. Moniter signs of hypovolemia, electrolyte imbalances, observe for bleeding.

Cholecystectomy

Incision into the gallbladder usually for drainage laparoscopic/open abdominal are the two procedures T-tube is inserted to keep the duct open and allow drainage of bile until the edema resolves/ removed after 24 hours. Laparo= most common, use laser/cautery to remove gallbladder,less invasive. Open abd= longer recovery, greater risk for infection. NI drain care, assess/treat pain, pt education, assess vital signs.

cholecystitis

Inflammation of gallbladder caused by an obstruction a gallstone or a tumor pt complains of indigestion s/s: pain in RUQ, anorexia,nausea, vomiting, flatulence, increased heart rate/resp, sweaty, low grade fever, elevated leukocyte NI/pt teaching: bed rest, NG tube, NPO status, IV fluids. Antispasmodic/analgesic drugs to decrease pain.

Pancreatitis

Inflammatory condition of the pancreas can be acute/chronic. Associated Factors: Biliary Tract Damage, Alcohol consumption, trauma, infectious disease or certain drugs. NI: Pain relief(Analgesic, antispasmodic medications), Bed rest,Enteral feeding Pt Teaching: low-fat,high-calorie, high carbohydrate diet. Alcohol/Caffeine are not allowed if full recovery is desired. Pt should understand disease process/severity

A patients brother asks the nurse why the patients pancreatic cancer is at stage 4 so early after the diagnosis. The nurse correctly identifies the late diagnosis and high mortality rates as being attributed to what factors?

It is difficult to diagnose pancreatic cancer at an early, curable stage. The majority of cancers have metastasized at the time of diagnosis. Early tumors often remain asymptomatic or "silent" until their grwoth is advanced. Patients often attribute the vague early symptoms of pancreatic cancer to problems that do not warrant seeking medical attention.

Discharge teaching in relation to home management following a laparoscopic cholecystectomy should include which instructions?

Keeping the bandages on the puncture sites for 48 hours

Laparoscopic cholecystectomy

Laser or cautery is used to remove the gallbladder

A nurse is reinforcing teaching with a client who has hepatitis B about home care. Which of the following instructions should the nurse include? (Select all that apply)

Limit Physical activity avoid alcohol eat small frequent meals

A patient has advanced cirrhosis of the liver with an acute exacerbation of hepatic encephalopathy. What type of food might be limited in his diet?

Meats

The nurse hears in report that several patients are scheduled for diagnostic testing the nurse must plan to take vital signs every 15 minutes 2 times then every 30 minutes four times and then every hour four times after which test?

Needle liver biopsy

Oral cholecystography.

Nurse checks allergy for Iodine six tablets every 5 minutes beginning after the evening meal. NPO status from midnight high fat meal or beverage to empty the gallbladder.

T tube cholangiogram

Postoperative cholangiography

Cholangiography

Radiographic examination of bile ducts

Cholecystography

Radiographic examination of gallbladder

After a laparoscopic cholecystectomy the patient reports shoulder pain what should the nurse do

Reassure that the pain is expected and give an analgesic as ordered

Cholecystectomy

Removal of gallbladder

A 78 year old patient is admitted with common bile duct obstruction related to cancer of the pancreas. Which clinical manifestations would the nurse expect to find? ( select all that apply)

Sceleral icterus Dark,tea colored urine Jaundice Mid epigastic pain

A first semesternursing student tells the nurse that she would like to teach and coach coughing and deep breathing for several patients which patients would be best for the nurse to recommend to the student

Scheduled to have a cholecystectomy in 2 days looks forward to having a liver transplant from a living donor prescribed several weeks of bed rest for chronic hepatitis

Lithotripsy

Series of shock wave through water or a cushion that breaks the stones into fragments

Hepatitis D

Similar transmission to those of HPV sexual transmission. Co-infection with hepatitis b

A patient has been admitted with right upper quadrant pain and has been placed on a low-fat diet. Which tray would be acceotable for her?

Skim milk, lean fish, tapioca pudding and fruit.

Malabsorption of Vitamin K

The cirrhotic liver cannot absorb VitK or produce the clotting factors VII,IX, and X. These factors cause the pt with cirrhosis to develop bleeding tendencies. Bruises easily, blood in urine/stool.

The nurse is caring for post operative cholecystectomy patient. The nurse includes coughing and deep breathing in the patients care plan based on what criteria?

The patient tends to take shallow breaths due to the placement of the incision

a patient with acute pancreatitis is refusing to have enough gastric tube inserted and wants to leave the hospital walk in the nurse say to help the patient to accept the therapy

The tube will decrease the nausea vomiting pain and abdominal distention

When caring for a patient with acute exacerbation of hepatic encephalopathy, the nurse may give a lactulose enema, provide a low-protein diet, and limit physical activity. The nurse explains to the patient that these measures are taken for what reason?

To decrease ammonia production.

Hepatitis B

Wash hands Preventive measures against is the HPV vaccine Transmitted via blood and body fluids People at risk for their virus or healthcare workers people who play or work an inner city parks and playgrounds are at risk for exposure to HPV and garbage containers and use needles and syringes Men who have sex with men individuals who use illicit IV drugs and those who travel to areas with high infection rate as well as individuals who travel internationally

Hepatitis C

Wash hands Transmitted by needle sharing among illicit IV drug users to avoid ensure proper disposal of needles use standard precautions need a list IV access devices

Infection and rejection of the organ

What are the primary risk associated with the planned transplant

A young woman who is pregnant is having symptoms of cholecystitis in the healthcare provider has informed for that diagnostic testing is required which information brochure will the nurse prepare for this patient

What you need to know about ultrasonography for the gallbladder

The surgical procedure for cancer of the pancreas involves resection of the antrum of the stomach, the gallbladder, the duodenum, and varying amounts of the pancreas. Anastomoses are constructed between the stomach , the common bile and pancreatic ducts, and the jejunum. The nurse correctly identifies this procedure with which name?

Whipple procedure

Hepatitis E

avoid drinking water or beverages with ice and Aries was uncertain water quality refrain from eating raw shellfish and avoid raw produce unless it is paired with purified water hepatitis is most often seen in South East and Central Asia the middle East Africa and Mexico

A nurse is reviewing nutrition teaching for a client who has cholecystitis. The nurse should identify that which of the following food choices is most likely to trigger cholecystitis?

brownie with nuts

Hepatitis A

fecal-oral transmission linked to food prep/handling in restaurants, improper hand hygiene hand hygiene/HAV vaccine

A nurse is collecting data from a client who has advanced cirrhosis. Which of the following findings indicates the client is experiencing hepatic encephalopathy?

change in orientation asterixis fetor hepaticus

A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take?

offer 8oz water following medication administration.

Cholelithiasis

presence of gallstones

A nurse is contributing to the plan of care for a client who has hepatitis B with ascites. Which of the following interventions should the nurse recommend?

provide a high-calorie, high-carbohydrate diet

needle liver biopsy

safe,simple, and valuable method of diagnosing pathologic liver conditions. Pt lies supine position with right arm over the head. hepatic tissue is removed for examination NI: Moniter vitals every 15 minutes, 30 minutes, every hour. Pt lies on right side for 2 hours to splint the puncture site. observe pt for signs of bleeding Complication: severe pain, pneumothorax (collapsed lung)

Choledocholithiasis

stones in common bile duct

a nurse is reviewing a new prescription for ursodiol with a client who has cholelithiasis. Which of the following information should the nurse include?

this medication dissolves gallstones gradually over a period of up to 2 years.

A nurse is reviewing the medical record of a client who has new diagnosis of hepatitis C. Which of the following laboratory findings should the nurse expect?

total bilirubin 4.5 mg/dL

A nurse is reviewing preoperative teaching with a client scheduled for a laparoscopic cholecystectomy. Which of the following should the nurse include?

you might have shoulder pain after surgery