Patho PrepU Chp 30

A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs, "more fluids in my vein?" The nurse responds:

"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."

The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points?

"Gallstones have developed, which are typically composed of cholesterol."

A 51 year-old male professional is in the habit of consuming 6 to 8 rum and cokes each evening after work. He assures the nurse practitioner who is performing his regular physical exam that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the client's statement?

"When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts."

A 70 year-old male with a 40 pack-year history of smoking and longstanding non-insulin dependent diabetes has been diagnosed with pancreatic cancer. Which of the following teaching points should the physician provide?

"You will likely be facing surgery in the near future, but know that this is very unlikely to eliminate your cancer."

Which client is most likely to develop hepatocellular cancer?

A client who has been diagnosed with metastatic breast cancer

The nurse recognizes hepatic encephalopathy may be aggravated by which of these situations?

A high protein meal

A client with multiple pain-related injuries to the back, knees, and hips is admitted with acute liver failure. Upon procuring a medication list, the nurse notes that the client is taking several over-the-counter medications that contain a preparation known to be the drug that most commonly causes liver failure. Which drug is in the client's medications?

Acetaminophen

While on tour, a 32 year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include temperature 46.8°C (101.8°F), blood pressure 89/48 mmHg and heart rate 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase and lipase are all elevated. Which of the following diagnoses would the care team suspect first?

Acute pancreatitis

The oncology nurse is teaching a group of nursing students about risk factors for pancreatic cancer. Which of these does the nurse include in the teaching session? Select all that apply.

Age over 50 years Chronic pancreatitis Cigarette smoking

A patient with pancreatic cancer is admitted for portal hypertension in which they are symptomatic with ascites. Following paracentesis and removal of 7.5 L of ascitic fluid the nurse should anticipate that the physician will order which of the following medications to assist in maintaining an effective circulating fluid volume?

Albumin (Human) 5%.

Which of these substances should the nurse teach the client with pancreatitis is essential to avoid?

Alcohol

The radiologic studies of a client identify partial obstruction of the sphincter of the pancreas. The nurse recognizes that this is a result of:

Alcoholic beverages

A client with history of alcohol abuse is brought to the emergency department after a weekend of heavy drinking, experiencing right upper quadrant pain, anorexia, nausea, jaundice and ascites. The nurse identifies these as manifestations of what disorder?

Alcoholic hepatitis

When assessing the client with acute pancreatitis, which of these diagnostic tests, consistent with the disease, does the nurse anticipate will be altered?

Amylase and lipase

A client presents with epigastric pain, a mild fever, nausea, and vomiting. His history shows a previous episode with similar symptoms that reverted in 24 hours. This time the pain is not subsiding. What diagnosis is the most likely?

Calculous cholecystitis

When caring for the client with pancreatic cancer, for which of these signs and symptoms does the nurse assess?

Central abdominal pain, jaundice and weight loss

All diseases have risk factors. What is the most significant environmental risk factor for pancreatic cancer?

Cigarette smoking

When assessing the nutritional intake of a client with generalized pancreatic cancer, which of these statements by the client is consistent with the disease and food intake?

Client states pain becomes worse with food intake.

A male infant who is 48 hours postpartum is undergoing phototherapy for the treatment of jaundice and accompanying high levels of bilirubin. Place the following components of the production of bilirubin in the correct chronological order. Use all the options.

Conjugated bilirubin Urobilinogen Red blood cells Biliverdin Free bilirubin

A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which of the following treatments is most likely to be effective for her?

Corticosteroids and immunosuppressant drugs

A 24-year-old woman undergoing a screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which treatment is most likely to be effective for her?

Corticosteroids and immunosuppressant drugs

The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes which of these altered diagnostic tests is consistent with development of edema?

Decreased albumin

A client with persistent, recurring episodes of epigastric and upper left quadrant pain and anorexia, nausea, vomiting, constipation, and flatulence has been diagnosed with chronic pancreatitis. What is the cause of the symptoms of chronic pancreatitis?

Destruction of both the endocrine and exocrine pancreas

Ascites is an accumulation of fluid in the peritoneal cavity and usually occurs in advanced cirrhosis. What is the treatment of choice for ascites?

Diuretics

A client newly diagnosed with pancreatic cancer is admitted to begin treatment. Which pain discriptors can be associated with adenocarcinomas of the pancreas?

Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward.

The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which of these ingested substances?

Fats

A client has just been diagnosed with cirrhosis and has been told he needs a transplant. What changes have occurred in the liver due to cirrhosis that results in an inability to heal and require transplant?

Fibrosis has occurred and there are constrictive bands that disrupt biliary flow.

The nurse is assessing a client with acute pancreatitis who denies use of alcohol. When teaching the client about additional causes of acute pancreatitis, the nurse includes which of these in the discussion? Select all that apply.

Gallstones Increased cholesterol Abdominal trauma

A client tells the nurse that he is concerned about developing hepatitis after being exposed to contaminated feces, saliva, and food. The nurse is aware that the client is at risk for:

Hepatitis A

A baby is born to a mother with active hepatitis B. Which of the following medications does the nurse anticipate administering today?

Hepatitis B immune globulin (HBIG).

A 29 year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What physiologic changes in the client's liver causing which of these altered diagnostic results does the nurse anticipate?

Hepatocellular necrosis evidenced by increased ALT and AST levels.

The physician suspects a client may have developed pancreatitis, and the physician has ordered laboratory blood work. Diagnosis-confirming results would identify:

High serum amylase and lipase

When caring for the client with acute pancreatitis, which of these alterations does the nurse recognize is consistent with the disease?

Hyperglycemia

The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which of these complications?

Hyperglycemia due to inability to synthesize insulin

The health care provider has completed the assessment of a client who presented to the emergency department with jaundice. The provider determines that the jaundice is a result of:

Impaired uptake of bilirubin by the liver

When caring for the client with Laennec's cirrhosis, the nurse recognizes which of these is an expected etiology of jaundice?

Impaired uptake of billirubin

The nurse is reviewing lab results of a client who has liver failure. The nurse determines that the client is at an increased risk for bleeding when the results include:

Increased prothrombin time

When caring for the client with hepatic failure, the nurse recognizes which of these problems places the client at increased risk for bleeding?

Increased prothrombin time

The nurse recognizes that which of these individuals are at risk for hepatitis B? Select all that apply.

Injection drug users Those having unprotected sex

The client in the GI clinic tells the nurse she is concerned she has something wrong with her gallbladder like what her friend with gallstones and inflammation had. Which of these complaints does the nurse recognize that supports the client's concern?

Intolerance to greasy food; burping

A client is prescribed erythromycin for an infection. What manifestations will the nurse recognize that indicate the onset of drug-induced cholestasis?

Jaundice and pruritus

The liver has many jobs. One of the most important functions of the liver is to cleanse the portal blood of old and defective blood cells, bacteria in the bloodstream, and any foreign material. Which cells in the liver are capable of removing bacteria and foreign material from the portal blood?

Kupffer cells

What laboratory markers are most commonly used to diagnose acute pancreatitis?

Lipase and amylase

The community health nurse is teaching about prevention of hepatitis A. Which of these groups does the nurse suggest will benefit from this vaccine?

Those traveling to third world countries

The nurse is caring for a client with asterixis. Which of these additional assessments should the nurse make to help a diagnosis of hepatic encephalopathy?

Mental status

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which of these descriptions?

Pain in the right upper quadrant referred to the same shoulder

When teaching the client about the cause of acute pancreatitis, which of these points should be included in the teaching session?

Pancreatic enzymes are activated before leaving the pancreas causing injury.

A client has been diagnosed with choledocholithiasis and acute suppurative cholangitis, which have been determined to be a surgical emergency. Surgery must take place promptly because:

the accumulation of purulent bile can cause sepsis.

When teaching a client at the GI clinic about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition?

Progressive destruction of the organ

Following a needlestick injury, a nurse develops hepatitis C. Even though they received the proper treatment within a timely manner, it develops into a chronic infection. The healthcare provider counsels the nurse to assess for which of the following major complications that can result from this chronic condition? Select all that apply.

Progressive liver fibrosis. Liver cancer.

The nurse is assessing a client who has just been admitted to the unit with a diagnosis of cholelithiasis. The nurse is aware that the client may manifest:

Right upper quadrant pain

A client who has been diagnosed with acute symptomatic viral hepatitis is now in the icteric period. The nurse would expect the client to manifest:

Severe pruritus and liver tenderness

When explaining the role of liver Kupffer cells to a group of nursing students, which of the following statements about the function of these cells is most accurate?

The cells are capable of removing and phagocytizing old and defective blood cells.

A 51 year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse he does not understand what the liver does in the body. Which of these statements best explains the liver's function?

The liver metabolizes most components of food and also cleans the blood of bacteria and drugs.

When caring for a client with primary biliary cirrhosis, which of these statements by the nurse will best teach the client about the cause of this problem?

There is autoimmune destruction of the bile ducts.

When assessing the client during the icteric phase of viral hepatitis, which of these findings does the nurse anticipate observing?

Yellow-tinged sclera

A 40 year-old man who uses heroin intravenously was diagnosed with hepatitis C (HCV) one year ago and now has chronic viral hepatitis. Which of the following statements by the client to his care provider would warrant correction by the nurse?

it is at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms.

A client has been diagnosed with alcohol-induced liver disease. He admits to the nurse, "I know what the lungs do, and I know what the heart does, but honestly, I have no idea what the liver does in the body." The nurse should tell the client that the liver:

metabolizes most components of food and also cleans the blood of bacteria and drugs.