Block 10 Module 6 Hepatobiliary Iggy Questions

B The client who has acute pancreatitis reports severe boring abdominal pain that is often rated by clients as a 10+ on a 0-10 pain scale. Nausea, vomiting, and fever may also occur, but that is not the client's priority for care.

A client is admitted with acute pancreatitis. What priority problem would the nurse expect the client to report? a. Nausea and vomiting b. Severe boring abdominal pain c. Jaundice and itching d. Elevated temperature

a. Sever boring abdominal pain b. Jaundice c. Nausea and/or vomiting e. Leukocytosis f. Dyspnea p 1186

A client was admitted to the hospital yesterday with a diagnosis of acute pancreatitis. What assessment findings will the nurse expect for this client? Select all that apply a. Sever boring abdominal pain b. Jaundice c. Nausea and/or vomiting d. Decreased serum amylase level e. Leukocytosis f. Dyspnea

C Jaundice, clay-colored stools, and dark urine are more commonly seen with chronic cholecystitis. The other symptoms are seen in clients with either chronic or acute cholecystitis.

A nurse assesses a client who has cholecystitis. Which sign or symptom indicates that this condition is chronic rather than acute? a. Temperature of 100.1° F (37.8° C) b. Positive Murphy sign c. Clay-colored stools d. Upper abdominal pain after eating

B, E, F Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the client's confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

A nurse assesses a client who has cirrhosis of the liver. Which laboratory findings would the nurse expect in clients with this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)

C This client has several indicators of sepsis with systemic inflammatory response. The nurse would notify the primary health care provider immediately. Documentation needs to be thorough but does not take priority. The client may appreciate warm blankets, but comfort measures do not take priority. The client may need insulin if blood glucose is being regulated tightly.

A nurse caring for a client notes the following assessments: white blood cell count 3800/mm3 (3.8 × 109/L), blood glucose level 198 mg/dL (11 mmol/L), and temperature 96.2° F (35.6° C). What action by the nurse takes priority? a. Document the findings in the client's chart. b. Give the client warmed blankets for comfort. c. Notify the primary health care provider immediately. d. Prepare to administer insulin per sliding scale.

D This client has a MEWS score of 7 (RR: 0, P: 3, SBP: 1, LOC: 1, Temperature: 1, UO: 1). Scores above 5 are associated with a high risk of death and ICU admission. The most important action for the nurse is to notify the Rapid Response Team so that timely interventions can be initiated. The client most likely will be transferred to the ICU, but an order is required. Monitoring the client every 30 minutes is appropriate, but the nurse needs to obtain care for the client. The charge nurse is a valuable resource, but the best action is to notify the Rapid Response Team.

A nurse on the general medical-surgical unit is caring for a client in shock and assesses the following: Respiratory rate: 10 breaths/min Pulse: 136 beats/min Blood pressure: 92/78 mm Hg Level of consciousness: responds to voice Temperature: 101.5° F (38.5° C) Urine output for the last 2 hours: 40 mL/hr. What action by the nurse is best? a. Transfer the client to the Intensive Care Unit. b. Continue monitoring every 30 minutes. c. Notify the unit charge nurse immediately. d. Call the Rapid Response Team.

c. Acute pain p 1180

A young adult client admitted with a diagnosis of cholecystitis and cholelithiasis has severe abdominal pain, nausea, and vomiting. Based on these assessment findings, which client problem is the highest priority for nursing intervention at this time? a. Anxiety b. Risk for dehydration c. Acute pain d. Malnutrition

C Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.

After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the client's understanding. Which statement made by the client indicates a need for further teaching? a. "I cannot drink any alcohol at all anymore." b. "I should not take over-the-counter medications." c. "I need to avoid protein in my diet." d. "I should eat small, frequent, balanced meals."

B The route of transmission for hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A

After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the client's understanding. Which statement by the client indicates correct understanding of the teaching? a. "Some medications have been known to cause hepatitis A." b. "I may have been exposed when we ate shrimp last weekend." c. "I was infected with hepatitis A through a recent blood transfusion." d. "My infection with Epstein-Barr virus can co-infect me with hepatitis A."

A,E Client teaching related to self-management of enzyme replacement therapy would include taking the enzymes with meals and snacks but not mixing enzyme preparations with protein-containing foods. Clients would not crush enteric-coated preparations and should swallow tablets without chewing to minimize oral irritation and allow the drug to be released slowly. Wiping lips after taking enzymes also minimizes skin irritation.

After teaching a client who has chronic pancreatitis and will be discharged with enzyme replacement therapy, a nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching? (Select all that apply.) a. "I will take the enzymes between meals." b. "The enteric-coated preparations cannot be crushed." c. "Swallowing the tables without chewing is best." d. "I will wipe my lips after taking the enzymes." e. "Enzymes should be taken with high-protein foods."

C The enzymes must be taken immediately before eating meals or snacks. If the client cannot swallow the capsules whole, they can be opened up and the powder sprinkled on applesauce, mashed fruit, or rice cereal. The client should wipe his or her lips carefully after drinking the enzyme preparation because the liquid could damage the skin. Protein items will be dissolved by the enzymes if they are mixed together.

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement by the client indicates a need for further teaching? a. "The capsules can be opened and the powder sprinkled on applesauce if needed." b. "I will wipe my lips carefully after I drink the enzyme preparation." c. "The best time to take the enzymes is immediately after I have a meal or a snack." d. "I will not mix the enzyme powder with food or liquids that contain protein."

A, C, D, E, F The client who has chronic pancreatitis has all of these signs and symptoms except he or she loses weight. Ascites and jaundice result from biliary obstruction; ascites is associated with portal hypertension. Steatorrhea is fatty stool that occurs because lipase is not available in the duodenum; because it is released by the disease pancreas into the bloodstream. Polydipsia, polyuria, and polyphagia result from diabetes mellitus, a common problem seen in clients whose pancreas is unable to release adequate amounts of insulin.

The nurse assesses a client who has chronic pancreatitis. What assessment findings would the nurse expect for this client? (Select all that apply.) a. Ascites b. Weight gain c. Steatorrhea d. Jaundice e. Polydipsia f. Polyuria

A Rapid removal of ascitic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the client's weight to drop as fluid is removed. To prevent hypovolemic shock, no more than 2000 mL are usually removed from the abdomen at one time. The patient's weight typically only decreases by less than 2 kg or 4.4 lb.

The nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding would require immediate action by the nurse? a. Urine output via indwelling urinary catheter is 20 mL/hr b. Blood pressure increases from 110/58 to 120/62 mm Hg c. Respiratory rate decreases from 22 to 16 breaths/min d. A decrease in the client's weight by 3 lb (1.4 kg)

C The client is exhibiting signs of hypovolemia most likely due to internal bleeding or hemorrhage. Due to decreased blood volume, the blood pressure is low and the heart rate increases to compensate for hypovolemia to ensure organ perfusion. Respirations often increase to increase oxygen in the blood.

The nurse documents the vital signs of a client diagnosed with acute pancreatitis: Apical pulse = 116 beats/min Respirations = 28 breaths/min Blood pressure = 92/50 What complication of acute pancreatitis would the nurse suspect that the client might have? a. Electrolyte imbalance b. Pleural effusion c. Internal bleeding d. Pancreatic pseudocyst

c. Wear gloves when touching the client d. Wear a gown when providing personal care to this patient p 1167

The nurse is caring for a client diagnosed with hepatitis A. Which transmission based precautions are required when providing care for this client? SATA a. Place the client in a private room b. Wear a mask when handling the patient bedpan c. Wear gloves when touching the client d. Wear a gown when providing personal care to this patient e. Wear eye goggles when providing care

a. Assess the client's neurologic status as prescribed c. Monitor the client's serum ammonia level p 1165

The nurse is caring for a client in end stage liver failure. Which interventions should be implemented when observing for hepatic encephalopathy? SATA a. Assess the client's neurologic status as prescribed b. Monitor the clients hemoglobin c. Monitor the client's serum ammonia level d. Monitor the client's electrolyte values daily e. Prepare to insert an esophageal balloon tamponade tube f. Make sure the clients fingernails are short

C Clients who have cirrhosis due to addiction may have alienated relatives over the years because of substance abuse. The nurse would assist the client to identify a friend, neighbor, clergy/spiritual leader, or group for support. The nurse would not minimize the patient's concerns. Attending AA may be appropriate, but this response doesn't address the client's concern. "Making peace" with the client's family may not be possible. This statement is not client-centered.

The nurse is caring for a client who has cirrhosis from substance abuse. The client states, "All of my family hates me." How would the nurse respond? a. "You should make peace with your family." b. "This is not unusual. My family hates me too." c. "I will help you identify a support system." d. "You must attend Alcoholics Anonymous."

B A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.

The nurse is caring for a client who has cirrhosis of the liver. What nursing action is appropriate to help control ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the patient daily.

D Hepatitis C is the leading cause of cirrhosis and an also cause liver cancer. Clients with nonalcoholic fatty liver disease often have metabolic syndrome and can also develop cirrhosis.

The nurse is caring for a client who has cirrhosis of the liver. Which risk factor is the leading cause of cirrhosis? a. Metabolic syndrome b. Liver cancer c. Nonalcoholic fatty liver disease d. Hepatitis C

A, B, C, D, E, F All of these assessment findings are very common for a client who has late-stage cirrhosis due to biliary obstruction and poor liver function. The client has vascular lesions and excess fluid from portal hypertension.

The nurse is caring for a client who has late-stage (advanced) cirrhosis. What assessment findings would the nurse expect? (Select all that apply.) a. Jaundice b. Clay-colored stools c. Icterus d. Ascites e. Petechiae f. Dark urine

A, B, C, D, E, F All of these choices are correct. Amylase and lipase are pancreatic enzymes that are released during pancreatic inflammation and injury. Leukocytes also increased due to his inflammatory response. Pancreatic injury affects the ability of insulin to be released causing increased glucose levels. Bilirubin is also typically increased due to hepatobiliary obstruction. Calcium and magnesium levels decrease because fatty acids bind free calcium and magnesium causing a lowered serum level; these changes occur in the presence of fat necrosis.

The nurse is caring for a client who has possible acute pancreatitis. What serum laboratory findings would the nurse expect for this client? (Select all that apply.) a. Elevated amylase b. Elevated lipase c. Elevated glucose d. Decreased calcium e. Elevated bilirubin f. Elevated leukocyte count

a. Prothrombin time b. Serum Bilirubin c. Albumin d. Aspartate aminotransferase (AST) e. Lactate dehydrogenase (LDH) p 1161

The nurse is caring for a client who is diagnosed with cirrhosis. Which serum lab values will the nurse expect to be abnormal? SATA a. Prothrombin time b. Serum Bilirubin c. Albumin d. Aspartate aminotransferase (AST) e. Lactate dehydrogenase (LDH) f. Acid phosphatase

A The purpose of administering lactulose to this patient is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The patient must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse would not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.

The nurse is caring for a client who is prescribed lactulose. The client states, "I do not want to take this medication because it causes diarrhea." How would the nurse respond? a. "Diarrhea is expected; that's how your body gets rid of ammonia." b. "You may take antidiarrheal medication to prevent loose stools." c. "Do not take any more of the medication until your stools firm up." d. "We will need to send a stool specimen to the laboratory as soon as possible."

D For safety, the patient would void just before a paracentesis to prevent bladder damage to the procedure. The primary health care provider would have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the side of the bed and leaning over the bedside table.

The nurse is caring for a client who is scheduled for a paracentesis. Which action is appropriate for the nurse to take? a. Have the client sign the informed consent form. b. Get the patient into a chair before the procedure. c. Help the client lie flat in bed on the right side. d. Assist the client to void before the procedure.

A, B, D, F Anemia and irritable bowel syndrome are unrelated to developing or worsening encephalopathy, which is caused by increased protein which breaks down into ammonia. Infection can cause hypovolemia which would increase serum protein concentration. Constipation and GI bleeding causes a large protein load in the intestines.

The nurse is caring for a client with early encephalopathy due to cirrhosis of the liver. Which factors may contribute to increased encephalopathy for which the nurse would assess? (Select all that apply.) a. Infection b. GI bleeding c. Irritable bowel syndrome d. Constipation e. Anemia f. Hypovolemia

B A low-protein diet is prescribed when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing the patient's dietary protein will cause complications of liver failure and would not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.

The nurse is caring for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic, and the family expresses distress that the patient is receiving little dietary protein. How would the nurse respond? a. "A low-protein diet will help the liver rest and will restore liver function." b. "Less protein in the diet will help prevent confusion associated with liver failure." c. "Increasing dietary protein will help the patient gain weight and muscle mass." d. "Low dietary protein is needed to prevent fluid from leaking into the abdomen."

A Although family members may be afraid that they will contract hepatitis C, the nurse would educate them about how the virus is spread. Hepatitis C is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needlesticks, unsanitary tattoo equipment, and sharing of intranasal drug paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the client's status with the brother.

The nurse is caring for a client with hepatitis C. The client's brother states, "I do not want to get this infection, so I'm not going into his hospital room." How would the nurse respond? a. "Hepatitis C is not spread through casual contact." b. "If you wear a gown and gloves, you will not get this virus." c. "This virus is only transmitted through a fecal specimen." d. "I can give you an update on your brother's status from here."

A, B, C, E, F Within the first hour of suspecting severe sepsis, the nurse would draw (or facilitate) serum lactate levels, obtain blood cultures (or other cultures), administer antibiotics (after the cultures have been obtained), begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L. and administer vasopressors if hypotensive during or after fluid resuscitation to maintain a mean arterial pressure ≥ 65 mm Hg. Initiating hemodynamic monitoring would be done after these "bundle" measures have been accomplished.

The nurse is caring for a client with suspected septic shock. What does the nurse prepare to do within 1 hour of the client being identified as possibly having sepsis? (Select all that apply.) a. Administer antibiotics. b. Draw serum lactate levels. c. Infuse vasopressors. d. Measure central venous pressure. e. Obtain blood cultures. f. Administer rapid bolus of IV crystalloids.

A, B, C, E Clients who have chronic pancreatitis need to avoid GI stimulants, including alcohol, caffeine, and nicotine. Food and snacks need to be high-calorie to prevent additional weight loss. Green vegetables can be consumed if tolerated by the client.

The nurse is preparing a client who has chronic pancreatitis about how to prevent exacerbations of the disease. Which health teaching will the nurse include? (Select all that apply.) a. "Avoid alcohol ingestion." b. "Be sure and balance rest with activity." c. "Avoid caffeinated beverages." d. "Avoid green, leafy vegetables." e. "Eat small meals and high-calorie snacks."

A, C, D Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush would be used to prevent gum bleeding, and the client's nails would need to be trimmed short to prevent the patient from scratching himself or herself. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap.

The nurse is teaching assistive personnel (AP) about care of a client who has advanced cirrhosis. Which statements would the nurse include in the staff teaching? (Select all that apply.) a. "Apply lotion to the client's dry skin areas." b. "Use a basin with warm water to bathe the patient." c. "For the patient's oral care, use a soft toothbrush." d. "Provide clippers so the patient can trim the fingernails." e. "Bathe with antibacterial and water-based soaps."

A, C, E Clients who are prescribed NPO while experiencing an acute pancreatitis episode may need enteral or parenteral nutrition. The nurse would collaborate with the registered dietitian nutritionist, clinical pharmacist, and primary health care provider to plan and implement the more appropriate nutritional interventions. The nursing assistant and certified herbalist would not assist with this clinical decision.

The nurse plans care for a client who has acute pancreatitis and is prescribed nothing by mouth (NPO). With which health care team members would the nurse collaborate to provide appropriate nutrition to this client? (Select all that apply.) a. Registered dietitian nutritionist b. Nursing assistant c. Clinical pharmacist d. Certified herbalist e. Primary health care provider

C. Measuring the drainage and documenting the findings Serosanguinous drainage stained with bile is expected and normal during the first 2 hours after traditional cholecystectomy. The drain is not to be clamped or irrigated. Placing the client in left lateral Sims' position can be done but is not related to drainage from the JP.

What action will the nurse take when, 12 hours after traditional cholecystectomy, a clients Jackson-Pratt (JP) drain shows serosanguinous drainage stained with bile? A. Placing the client to the left lateral Sims position B. Clamp the drain intermittently for 30 minutes every hour C. Measuring the drainage and documenting the findings D. Disconnecting the suction device and gently irrigating the drain with sterile saline

C. You can receive an immunoglobulin injection to prevent infection. Receiving immunoglobulin with a high concentration of anti-hepatitis. A antibodies within two weeks of exposure can prevent an expose person from developing the infection. Receiving the vaccination at this time takes too long to develop sufficient immunity to prevent an infection from this exposure.

What is the nurses best response to a client who fears he may have been exposed to hepatitis A while attending a banquet last week after which three restaurant workers were diagnosed with hepatitis A? A. Which types of food did you eat at the banquet? B. If you have no symptoms at this time, you are probably safe. C. You can receive an immunoglobulin injection to prevent infection. D. Contact your primary healthcare provider about receiving the hepatitis A vaccine

C. Assessing for abdominal rigidity and taking the clients temperature Increasing abdominal pain and the presence of chills in a client who has ascites indicates possible spontaneous bacterial peritonitis. The nurse would perform a complete abdominal assessment and assess for a temperature elevation before notifying the primary healthcare provider.

What is the nurses priority action when a client with ascites reports increased abdominal pain and chills? A. Applying oxygen and making the client NPO B. Notifying the primary healthcare provider immediately C. Assessing for abdominal rigidity and taking the clients temperature D. Applying a heating blanket and raising the head of bed to a 45° angle

A. Initiate the rapid response team The client is exhibiting symptoms associated with biliary colic and possible shock. This is an emergency and, if the clients primary healthcare provider is not immediately available, initiating the rapid response team is a priority.

What is the nurses priority action when caring for a client with acute cholecystitis who now has severe abdominal pain, diaphoresis, heart rate of 118 beats/min, BP 95/70, respirations 32 breaths/min, and temperature 101°F 38.3°C? A. Initiate the rapid response team B. Assisting the client to a semi Fowler position C. Administering the prescribed opioid analgesic D. Auscultating the clients abdomen in all four quadrants

A. Apply oxygen Left lower lung infusions, atelectasis, and ammonia often develop in clients with acute pancreatitis, especially in older adults, and can lead to pulmonary failure and death. The nurse would first apply oxygen and then immediately notify the primary healthcare provider.

Which action will the nurse take when an eight-year-old client with a cute pancreatitis has no breath sounds in the left lower lung lobe? A. Apply oxygen B. Assess the breast sounds on the right C. Notify the primary healthcare provider D. Document the findings as the only action

A. Do not crush or chew the capsules B. Take these drugs with all meals and snacks E. Check your stools for amount and presents of fat to a what the drugs are working PERT is used to assist in the digestion of food. Thus, it must be taken orally only whenever the client eats a meal or snack. Capsules are not to be open, crushed, or chewed for maximum benefit. The amount of fat and stores, as well as the amount and consistency of stools are used to evaluate PERT effectiveness. It is not necessary to remain upright, and the drug does not cause or increase photo sensitivity.

Which actions and precautions will the nurse educated client with chronic pancreatitis about when starting pancreatic enzyme replacement therapy (PERT)? Select all that apply A. Do not crush or chew the capsules B. Take these drugs with all meals and snacks C. Sit in an upright position for at least 30 minutes after taking the drug D. Where sunscreen and protective clothing outdoors to revent sever of sunburn E. Check your stools for amount and presents of fat to a what the drugs are working F. f you are too nauseated to eat or to take the drug, go to an emergency department for an injectable form of the drug

A. Washing hands before and after contact with all clients B. Using a needleless system for parenteral therapy C. Using standard precautions with all clients regardless of age or sexual orientation D. Obtaining an immunoglobulin injection after exposure to hepatitis A E. Being fully vaccinated with the hepatitis B vaccine With the exception of F, all actions are effective in preventing or reducing transmission of infectious hepatitis among healthcare workers as a result of occupational exposure. Wearing gloves during direct contact with all clients may give a false sense of security and does not prevent transmission, if gloves are contaminated and then come into contact with another person. Gloves are not needed for all client contact.

Which actions are most effective for nurses and other healthcare workers to prevent occupational transmission of viral hepatitis? Select all that apply A. Washing hands before and after contact with all clients B. Using a needleless system for parenteral therapy C. Using standard precautions with all clients regardless of age or sexual orientation D. Obtaining an immunoglobulin injection after exposure to hepatitis A E. Being fully vaccinated with the hepatitis B vaccine F. Wearing gloves during direct contact with all clients

C. Asking the client to void before procedure E. Weighing before the procedure F. Assessing the respiratory rate and blood pressure Vital signs including weight, are taken before the procedure to use as a baseline for changes after the procedure. Weight is important because it can help determine the volume of fluid removed, clients are expected to weigh less after a paracentesis. Having the client boy before the procedure helps forvent injuried the bladder. The healthcare provider performing the parasinthesis is responsible for obtaining the informed consent, not the nurse. The pint does not need to be in PO before the procedure. The client position with the head of the bed.

Which actions will the nurse perform when preparing a client for paracentesis? Select all the apply A. Obtaining informed consent B. Maintaining the client on NPO status C. Asking the client to void before procedure D. Placing the client in the flat supine position E. Weighing before the procedure F. Assessing the respiratory rate and blood pressure

A. Maintaining the client on NPO status D. Providing opioids by patient controlled analgesia F. Assisting the client to a sideline position with these drawn up to the chest Pain can be reduced by preventing pancreatic stimulation by keeping the client NPO. Opioids are needed for severe pain and her best provided by PCA. Clients may obtain some pain relief from a sideline position with the knees drawn closely to the chest. NSAIDs are not used and pancreatic enzyme replacement therapy would only make the pancreatitis worse at this time. NG tube placement is reserved for only the clients who have continuous vomiting or biliary obstruction.

Which actions will the nurse take to help relieve the severe pain in a client with acute pancreatitis? Select all that apply A. Maintaining the client on NPO status B. Administering oral NSAIDs around the clock C. Inserting a nasogastric (NG) tube to low suction D. Providing opioids by patient controlled analgesia E. Administering pancreatic enzyme replacement therapy F. Assisting the client to a sideline position with these drawn up to the chest

b. eat soft foods and cool liquids c. do not engage in strenuous activities or heavy lifting Esophageal varices are thin walled blood vessels that bleed easily with mechanical irritation or any increase in pressure within the portal system. Clients must avoid any activities that increase intra-abdominal pressure such as strenuous exercise and heavy lifting. Hard or rough foods can mechanically open the varices and cause bleeding. Avoiding alcohol may prevent worsening liver problems but does not directly prevent bleeding or hemorrhage. None of the other activities alter intra-abdominal pressure or prevent direct injury to the varices.

Which activities are most important for the nurse to teach a client with esophageal varices to prevent harm from bleeding or hemorrhage? SATA a. avoid alcoholic beverages b. eat soft foods and cool liquids c. do not engage in strenuous activities or heavy lifting d. try to eat six smaller meals daily instead of 3 larger ones e. be sure to keep your mouth open when sneezing or coughing f. cross your legs only at the ankles when sitting, rather than the knees

A. Bile duct injuries are rare B. Complications are uncommon C. Postoperative pain is less severe F. Depending on the nature of the job some clients can return to work within 1 to 2 weeks Injuries and complications are much lower than traditional cholecystectomy and the postoperative pain is less severe. Many clients can resume their normal activities within one week. The mortality rate is very low, much lower than traditional cholecystectomy. Although the infection rate is low there still an infection risk any time and incision is made.

Which advantages of minimally invasive surgery (MIS) laparoscopic cholecystectomy will the nurse reinforce to the client after the surgeon has provided information for informed consent? Select all that apply A. Bile duct injuries are rare B. Complications are uncommon C. Postoperative pain is less severe D. Mortality is about equal to that of traditional cholecystectomy E. IV anabiotic's are not needed because infection does not occur F. Depending on the nature of the job some clients can return to work within 1 to 2 weeks

A. Ascites B. Hypotension D. Hyponatremia E. Dependent edema Serum albumin maintains plasma oncotic pressure and sodium levels in the normal range. When albumin levels are low, plasma volume decreases as fluid leaks into the abdomen and dependent areas, forming ascites and dependent edema. Sodium follows the albumin, making serum sodium levels low. The decreased plasma volume results in hypotension.

Which assessment findings will the nurse expect in a client with late stage liver cirrhosis whose total serum albumin level is low? Select all that apply A. Ascites B. Hypotension C. Hyperkalemia D. Hyponatremia E. Dependent edema F. Decreased serum ammonia levels

D. Weighing the client daily at the same time of the day Although measuring abdominal girth can show increases in girth that can be interpreted as more ascites, weighing the client provides more accurate information of water retention in abdominal and dependent areas.

Which assessment technique will the nurse use to most accurately determine increasing ascites in a client with advanced liver cirrhosis and portal hypertension? A. Interpreting the serum albumin value B. Measuring the clients abdominal girth C. Testing stool for the presence of occult blood D. Weighing the client daily at the same time of the day

C. Hypocalcemia The free or unbouncerum calcium level is usually low in client to have a cute pancreatitis as a result of fat necroses and the inability of the body to use protein bound calcium.

Which changing electrolyte values will the nurse expect in a client with acute pancreatitis he reports numbness around the mouth and leg muscle twitching? A. Hyponatremia B. Hypokalemia C. Hypocalcemia D. Hypochloremia

b. 45 yr old man with hep C infection and chronic use of acetaminophen Postnecrotic cirrhosis of the liver is caused by viral hepatitis, esp hep C and drugs that are toxic to the liver, such as acetaminophen. Cirrhosis caused by chronic alcoholism is Laennec cirrhosis. Chronic biliary obstruction can result in biliary cirrhosis. Gallstones are not associated with cirrhosis unless chronic biliary obstruction is also present.

Which client's previous health history will the nurse most associate with a risk for developing postnecrotic cirrhosis of the liver? a. 28 yr old woman who had gallstones 1 year ago and has recently lost 20 lb on low cal, low fat diet b. 45 yr old man with hep C infection and chronic use of acetaminophen c. 50 yr old man who has many years of excessive alcohol consumption d. 55 yr old woman who has chronic biliary obstruction

b. Infection c. Opioids e. GI bleeding f. High-protein diet Factors that may contribute to or worsen hepatic encephalopathy in patients with cirrhosis include high-protein diet, infection, hypovolemia, hypokalemia, constipation, GI bleeding (causing large protein load in the intestines), and some drugs, especially hypnotics, opioids, sedatives, analgesics, diuretics, illicit drugs.

Which common factors will the nurse recognize as contributing to or worsening of hepatic encephalopathy in clients with liver cirrhosis? SATA a. Anorexia b. Infection c. Opioids d. Diarrhea e. GI bleeding f. High-protein diet g. Diabetes mellitus h. Chronic confusion

d. Vitamin K Clients with advanced liver disease, such as cirrhosis with ascites, are unable to metabolize fats and absorb fat-soluble vitamins from the GI tract. As a result, vitamin K is deficient. (Vit C is water soluble)

Which essential nutrient will the nurse expect to be deficient in a client who has liver cirrhosis and ascites? a. Potassium c. Vitamin C d. Vitamin K

C. Asking the client if he or she has passed flatulence or had a stool The best indicator of malfunction and adequate utility is the actual passage of flatus or stool. Bow sounds may still be present in the presence of an a dynamic alias. A CT scan is static and does not indicate motility. Gastric contents cannot indicate in bowl motelity.

Which is the most effective action for the nurse to take to assess adequate bowel function in a client with acute pancreatitis who is at risk for development of paralytic (adynamic) ileus? A. Observing contents of the nasal gastric drainage B. Listening for bowel sounds in all four abdominal quadrants C. Asking the client if he or she has passed flatulence or had a stool D. Interpreting the report of a CT scan of the abdomen with contrast medium

A. Asterixis A late finding in clients who have late stage liver cirrhosis and encepholopathy is asterixis, which is a coarse tremor that is characterized by rapid, nonrhythmic extensions and flexions of the wrist and fingers a.k.a. hand flapping or liver flapping.

Which neuromuscular assessment change indicates to the nurse that the client who has late stage liver cirrhosis now has encephalopathy? A. Asterixis B. Positive Chvostek sign C. Increased deep tendon reflex responses D. Decreased deep tenden reflex responses

B. Measuring heart rate, blood pressure, and oxygen saturation The client with acute pancreatitis is a high-risk for death from hemorrhage and shock as a result of necrotic blood vessels destroyed by enzymatic digestion. Although all of the above assessments are appropriate, the priority is to determine whether any indications of internal hemorrhage and shock are present.

Which nursing assessment has the highest priority for the nurse to perform on a client admitted in severe pain with acute pancreatitis? A. Asking the client to rate the level of pain B. Measuring heart rate, blood pressure, and oxygen saturation C. Auscultating bowel sounds in all four abdominal quadrants D. Determining the amount of alcoholic beverages the client consumes daily

A. Avoid taking acetaminophen or drinking alcohol Although all of the list precautions are important, the most important is the avoidance of acetaminophen and alcohol. These substances are toxic deliver and will worse in the clients liver disease.

Which precaution is most important for the nurse to instruct a client with cirrhosis in his or her family about continuing care in the home? A. Avoid taking acetaminophen or drinking alcohol B. Maintain one floor living to prevent excessive fatigue C. Use cool baths to reduce the sensation of itching D. Report any change in cognition to the healthcare provider

B. Potassium 6.4 and mEq/L Although the sodium and calcium levels are slightly low, they do not pose a significant risk at this time. The serum potassium level is well above normal, which may be related to the spironolactone therapy because it causes sodium excursion in potassium retention, and must be reported to the primary healthcare provider immediately. The sodium chloride level is normal.

Which serum electrolyte value in a client with early stage ascites from chronic liver disease who is taking spironolactone will the nurse report immediately to the primary healthcare provider? A. Sodium 133 mEq/L B. Potassium 6.4 and mEq/L C. Chloride 101 mEq/L D. Calcium 8.9 mg/dL

A. Amylase B. Bilirubin D. Lipase F. Glucose With acute pancreatitis, the pancreatic enzymes amylase and lipase are elevated. Bilirubin also is usually elevated as a result of biliary dysfunction or obstruction. Blood glucose levels are often elevated because pancreatic secretions of insulin is reduced. Most often, magnesium and calcium levels are decreased.

Which serum laboratory values will the nurse expect to be elevated and a client who has acute pancreatitis? Select all that apply A. Amylase B. Bilirubin C. Calcium D. Lipase E. Magnesium F. Glucose

A. Pruritis C. Pale, clay colored stools D. Dark, coffee colored urine John this is a yellow discoloration of the skin and mucus membranes from excessive Billy Rubin in the structures and blood. John this is accompanied by intense inching,. The excess bilirubin is excreted in the urine, turning it dark and coffee colored. The obstruction prevents bilirubin from reaching the intestinal system where it's broken down and gives stole it dark brown color because of this the bilirubin does not reach the G.I. tract, stools are a light with a gray or clay color

Which signs and symptoms will the nurse expect to find on an assessment of a client who is admitted with obstructive jaundice? Select all that apply A. Pruritis B. Hypertension C. Pale, clay colored stools D. Dark, coffee colored urine E. Pink discoloration of the sclera F. Bright red bleeding from the gums

a. Pruritus b. Icterus d. Pale, clay colored stools e. Dark, coffee colored urine f. Jaundice Bilirubin is a bile pigment. Elevated serum bilirubin levels stain the skin yellow (jaundice) and the eyes yellow (icterus). Jaundice is accompanied by intense itching. The excess bilirubin is excreted in the urine, turning it dark and coffee colored. With liver disease and reduced function, the bilirubin does not reach the intestinal system where it is normally broken down to give stool its dark brown color, because the bilirubin does not reach the GI tract, stools are light with a gray or clay color.

Which signs and symptoms will the nurse expect to find on assessment of a client with chronic liver disease who has an elevated serum bilirubin level? Select all that apply a. Pruritus b. Icterus c. Hypertension d. Pale, clay colored stools e. Dark, coffee colored urine f. Jaundice

A. Anorexia B. Jaundice D. Steatorrhea (fatty stools) E. Eructation (belching) F. Rebound tenderness Characteristics signs and symptoms of Cholecystitis include episodic or vague upper abdominal pain or discomfort that can radiate to the right shoulder, pain triggered by a high fat or high volume meals, anorexia, nausea and/or vomiting, dyspepsia, eructation(belching), flatulence, feeling of abdominal fullness, rebound tenderness (Bloomberg sign), and fever. Additional symptoms include jaundice and fatty stools (Steatorrhea)

Which signs or symptoms will the nurse assess for an a client who is suspected of having cholecystitis? Select all that apply A. Anorexia B. Jaundice C. Ascites D. Steatorrhea E. Eructation F. Rebound tenderness

D. "My right arm and shoulder always seem to hurt after I eat fried foods." Cholecystitis and cholelithiasis can cause referred pain to the right shoulder area, including under the right shoulder blade. Dark, tarry stools are associated with G.I. bleeding. Bad tasting fluid or vomit us in the mouth at night is related to Gastro esophageal reflux disease. Becoming sweaty and nauseated after meal is associated with dumping syndrome not gallbladder disease.

Which statement indicates to the nurse of a client who is experiencing frequent episodes of indigestion and flatulence may have cholecystitis? A. "My stools are sometimes very dark and tarry looking" B. "Sometimes at night I have bad tasting fluid in my mouth." C. "Usually about a hour after I eat I become sweaty and nauseated." D. "My right arm and shoulder always seem to hurt after I eat fried foods."

C. "Although they do not contain fat, I will avoid chocolate and caffeine." D. "If vomiting or diarrhea occur, I will call my primary healthcare provider." F. "I am planning on joining alcohol and licks anonymous and giving up drinking all together." Recommendations for diet therapy during recovery from an acute pancreatitis include small, frequent, moderate to high carb, high protein, low fat meals with bland, non-spicy foods, avoidance of alcohol, and avoidance of all G.I. stimulants such as caffeine containing food like tea, coffee, cola and chocolate. If clients start to have nausea, vomiting, or diarrhea after eating, here she is instructed to notify their provider.

Which statements about eating habits and diet therapy indicate to the nurse that the client recovering from acute pancreatitis understand the recommendations made in collaboration with the registered dietitian nutritionist? Select all that apply A. "Now I can go back to my usual three meals a day" B. "Replacing carbs with protein will speed up my recovery." C. "Although they do not contain fat, I will avoid chocolate and caffeine." D. "If vomiting or diarrhea occur, I will call my primary healthcare provider." E. "I can't wait to have some good, spicy Mexican food after all this hospital food." F. "I am planning on joining alcohol and licks anonymous and giving up drinking all together."

A. Decreased confusion D. 2 to 3 soft stools daily F. Lower serum ammonia levels Lactulose helps reduce encephalopathy by increasing stools, which causes a loss of some nitrogen producing bacteria in the intestinal tract. This loss reduces ammonia levels and helps decrease confusion. Lactulose does not affect serum bilirubin levels or increase urine output. A musty odor of the breath or fetor hepaticus is an indication of worsening encephalopathy.

Which symptoms in a client with cirrhosis and encephalopathy indicate to the nurse that the prescribed lactulose therapy is effective? Select all that apply A. Decreased confusion B. Increased urine output C. Musty odor to the breath D. 2 to 3 soft stools daily E. Lower serum bilirubin levels F. Lower serum ammonia levels