ch 25: biliary

The nurse reviews the laboratory values for a patient being evaluated for alcoholic cirrhosis. The nurse is aware that a diagnostic indicator present in greater than 70% of cases is which of the following? Alkaline phosphatase AST/ALT ratio >3.0 Albumin Total bilirubin

AST/ALT ratio >3.0 The aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is helpful in diagnosing liver damage and is present in more than 70% of cases.

What is a major concern for the nurse when caring for a patient with chronic pancreatitis? Pain Mental status changes Weight loss Nausea

Weight loss Weight loss is a major problem in chronic pancreatitis. More than 80% of patients experience significant weight loss, which is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack (Bope & Kellerman, 2011).

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? Pancreatitis Cholecystitis Peptic ulcer Appendicitis

Pancreatitis Hypotension is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. The other conditions are less likely to exhibit fluid volume deficit.

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? Reserving a site for a peripherally inserted central catheter (PICC) Limiting I.V. fluid intake according to the physician's order Providing the client with plenty of P.O. fluids Providing generous servings at mealtime

Reserving a site for a peripherally inserted central catheter (PICC) Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve a site for placement of a PICC, which enables the client to receive long-term total parenteral nutrition. Clients in the acute stages of pancreatitis also require large volumes of I.V. fluids to compensate for fluid loss.

A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client? Ammonium chloride Acetazolamide Furosemide Spironolactone

Spironolactone v The use of diuretic agents along with sodium restriction is successful in 90% of clients with ascites. Spironolactone, an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. When used with other diuretic agents, spironolactone helps prevent potassium loss. Oral diuretic agents such as furosemide may be added but should be used cautiously because long-term use may induce severe hyponatremia (sodium depletion). Acetazolamide and ammonium chloride are contraindicated because of the possibility of precipitating hepatic encephalopathy and coma.

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? Increased serum calcium levels Elevated urine amylase levels Decreased white blood cell count Decreased liver enzyme levels

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.

A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction? Paracentesis Liver transplantation High-dose corticosteroids Azathioprine

High-dose corticosteroids Drug-induced hepatitis occurs when a drug reaction damages the liver. This form of hepatitis can be severe and fatal. High-dose corticosteroids usually administered first to treat the reaction. Liver transplantation may be necessary. Paracentesis would be used to withdraw fluid for the treatment of ascites. Azathioprine (Imuran) may be used for autoimmune hepatitis.

After undergoing a liver biopsy, a client should be placed in which position? Supine position Right lateral decubitus position Prone position Semi-Fowler's position

Right lateral decubitus position After a liver biopsy, the client is placed on the right side (right lateral decubitus position) to exert pressure on the liver and prevent bleeding. Semi-Fowler's position and the supine and prone positions wouldn't achieve this goal.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? Vasopressin Nitroglycerin Spironolactone Cimetidine

Vasopressin 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. Spironolactone and cimetidine do not decrease portal hypertension.

Gynecomastia is a common side effect of which of the following diuretics? Nitroglycerin (IV) Furosemide Spironolactone Vasopressin

Spironolactone Gynecomastia is a common side effect caused by spironolactone. Vasopressin is used for bleeding esophageal varices and is not a diuretic. Nitroglycerin (IV) may be used with vasopressin to counteract the effects of vasoconstriction from the vasopressin.

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? Potassium Vitamin K Oral bile acids Vitamin B

Vitamin K Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

The nurse is preparing a teaching tool on pancreatic cancer. Which risk factor(s) will the nurse include in this tool? Select all that apply. Cigarette smoking Diabetes Aspirin use Obesity Alcohol intake

Cigarette smoking Diabetes Obesity Alcohol intake The incidence of pancreatic cancer increases with age, peaking in the seventh and eighth decades for both men and women. Risk factors for the development of pancreatic cancer include obesity and diabetes. The risk of pancreatic cancer is greater in those with a history of increased pack years of cigarette smoking and in those with high alcohol intake. Aspirin use is not an identified risk factor for the development of pancreatic cancer.

Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? Providing intensive insulin therapy Allowing a clear liquid diet during the acute phase Administering oral analgesics around the clock Maintaining a high-Fowler's position

Providing intensive insulin therapy Intensive insulin therapy (continuous infusion) in the critically ill client has undergone much study and has shown promise in terms of positive client outcomes when compared with intermittent insulin dosing. Glycemic control with normal or near normal blood glucose levels improves client outcomes. Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration, even with insulin coverage. Clients with pancreatitis should not be given high-fat foods because they are difficult to digest. The current recommendation for pain management in this population is parenteral opioids. The nurse should maintain the client in a semi-Fowler's position to reduce pressure on the diaphragm.

The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis? Severe mid-abdominal to upper abdominal pain radiating to both sides and to the back Sharp, stabbing pain in the left lower quadrant of the abdomen Dull pain, points to epigastric area Severe abdominal pain that radiates to the right shoulder

Severe mid-abdominal to upper abdominal pain radiating to both sides and to the back The most common complaint of clients with pancreatitis is severe mid-abdominal to upper abdominal pain, radiating to both sides and straight to the back. The other answers are not pain that is usually associated with acute pancreatitis.

A patient who has undergone liver transplantation is ready to be discharged home. The nurse is providing discharge teaching. Which topic will the nurse emphasize most related to discharge teaching? The patient will take immunosuppressive agents as required. The patient will exercise three times a week. The patient will monitor for signs of liver dysfunction. The patient will obtain measurement of drainage from the T-tube.

The patient will take immunosuppressive agents as required. The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to assure that an adequate supply of medication is available so that there is no chance of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient to measure drainage from a T-tube as a patient wouldn't go home with a T-tube. The nurse may teach the patient about the need to exercise or what the signs of liver dysfunction are, but these are not as important as the immunosuppressive drug regimen.

The nurse instructs a client on care at home after a laparoscopic cholecystectomy. Which client statement indicates that teaching has been effective? "I can drive after 2 weeks." "I can take a shower in a week." "I should wash the site with mild soap and water." "I should remain on bed rest for several days."

"I should wash the site with mild soap and water." After a laparoscopic cholecystectomy, the client should be instructed about pain management, activity and exercise, wound care, nutrition, and follow-up care. The client should be directed to wash the puncture site with mild soap and water when caring for the wound. When resuming activity, the client should be instructed to drive after 3 or 4 days, take a shower or bath after 1 or 2 days, and begin light exercise such as walking immediately.

Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve? 1 to 2 13 to 18 6 to 12 3 to 5

6 to 12 Ursodeoxycholic acid (UDCA [URSO, Actigall]) and chenodeoxycholic acid (chenodiol or CDCA [Chenix]) have been used to dissolve small, radiolucent gallstones composed primarily of cholesterol. Six to 12 months of therapy are required in many clients to dissolve stones, and monitoring of the client for recurrence of symptoms or occurrence of side effects (e.g., GI symptoms, pruritus, headache) is required during this time.

A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis? Caffeine consumption and acute pancreatitis Alcohol consumption and smoking Acute hepatitis and alcohol consumption Malnutrition and acute pancreatitis

Alcohol consumption and smoking Alcohol consumption in Western societies is a major factor in the development of chronic pancreatitis, as is smoking. Because heavy drinkers usually smoke, it is difficult to separate the effects of the alcohol abuse and smoking. Malnutrition is a major cause of chronic pancreatitis worldwide, but alcohol consumption is more commonly the cause in Western societies. Caffeine consumption is not related to acute pancreatitis. Acute hepatitis does not usually lead to chronic pancreatitis unless complications develop.

A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have? Weight loss Bile-stained vomiting Warm, dry skin Hypertension

Bile-stained vomiting Nausea and vomiting are common in acute pancreatitis. The emesis is usually gastric in origin but may also be bile stained. Fever, jaundice, mental confusion, and agitation may also occur.

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? Maintaining adequate nutritional status Relieving abdominal pain Teaching about the disease and its treatment Preventing fluid volume overload

Relieving abdominal 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.

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? "You must have the second one in 2 weeks and the third in 1 month." "You must have the second one in 1 year and the third the following year." "You must have the second one in 6 months and the third in 1 year." "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.

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern? The skin on the client's abdomen has multiple spider-shaped blood vessels. The client has gained 2 kg from the previous day. The client reports nausea and anorexia. The client's hands flap back and forth when the arms are extended.

The client's hands flap back and forth when the arms are extended. Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy. It indicates that the client has hepatic encephalopathy and, if untreated, a hepatic coma may occur.

A client is receiving vasopressin for the urgent management of active bleeding due to esophageal varices. What most serious complication should the nurse assess the client for after the administration? Urinary output changes Electrolytes level changes Electrocardiogram changes Liver enzyme changes

Electrocardiogram changes Vasopressin (Pitressin) is administered during the management of an urgent situation with an acute esophageal bleed because of its vasoconstrictive properties in the splanchnic, portal, and intrahepatic vessels. This medication also causes coronary artery constriction that may dispose clients with coronary artery disease to cardiac ischemia; therefore, the nurse observes the client for evidence of chest pain, ECG changes, and vital sign changes. Vasopressin will does not infer with urinary output, electrolytes, or liver enzymes.

A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client? Propranolol Lactulose Octreotide Spironolactone

Octreotide In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Octreotide (Sandostatin) causes selective splanchnic vasoconstriction by inhibiting glucagon release and is used mainly in the management of active hemorrhage. Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in clients with known varices and to prevent rebleeding. Beta-blockers should not be used in acute variceal hemorrhage, but they are effective prophylaxis against such an episode. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Lactulose (Cephulac) is administered to reduce serum ammonia levels in clients with hepatic encephalopathy.

A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply. Ingestion of undercooked beef Sexual activity Infection at school Suboptimal sanitary habits Consumption of sewage-contaminated water or shellfish

Sexual activity Infection at school Suboptimal sanitary habits Consumption of sewage-contaminated water or shellfish Typically, a child or a young adult acquires the infection at school through poor hygiene, hand-to-mouth contact, or close contact during play. The virus is carried home, where haphazard sanitary habits spread it through the family. An infected food handler can spread the disease, and people can contract it by consuming water or shellfish from sewage-contaminated waters. Outbreaks have occurred in day care centers and institutions as a result of poor hygiene among people with developmental disabilities. Hepatitis A can be transmitted during sexual activity. It is not contracted through the consumption of undercooked beef.

A client with acute pancreatitis is prescribed hydromorphone 2 mg intranvenously every 4 hours as needed for severe pain. Which assessment will the nurse prioritize for this client? Heart sounds Bowel sounds Bleeding tendency Development of nausea

Bowel sounds Adequate administration of analgesia is essential during the course of acute pancreatitis to provide sufficient pain relief and to minimize restlessness, which may further stimulate pancreatic secretion. Pain relief may require parenteral opioids such as morphine, fentanyl, or hydromorphone. Gastrointestinal paralysis and ileus are common problems in early acute pancreatitis that can be potentiated and aggravated by the use of high-dose opioids. Although opioids can affect heart rate, assessing the effect on heart sounds would not be the priority over assessing for bowel sounds in acute pancreatitis. Bleeding tendency would be a priority if the client is taking nonsteroidal anti-inflammatory drugs. Nausea is not identified as a potential adverse effect when a client with acute pancreatitis receives opioids for pain management.

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated."

"This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." If pain occurs in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure), the nurse may recommend using a heating pad for 15 to 20 minutes hourly, sitting up in a bed or chair, or walking.

A patient who had surgery for gallbladder disease has just returned to the unit. The nurse caring for this patient knows to immediately report what assessment finding to the primary care provider? Drainage of "bile-colored fluid" onto the abdominal dressing Acute pain with movement Rigidity of the abdomen Decreased breath sounds

Rigidity of the abdomen The location of the subcostal incision will likely cause the patient to take shallow breaths to prevent pain, and this may result in decreased breath sounds. The nurse should remind patients to take deep breaths and cough to expand the lungs fully and prevent atelectasis. Acute pain is an expected assessment finding following surgery, and analgesics should be administered for pain relief. Abdominal splinting or application of an abdominal binder may assist in reducing the pain. Bile may continue to drain from the drainage tract after surgery, and this will require frequent changes of the abdominal dressing. Increased abdominal tenderness and rigidity should be reported immediately to the health care provider, as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure.

A 50-year-old woman has a long history of hospital admissions related to alcohol abuse and consequent liver failure. During this present admission, the patient has been diagnosed with hepatic encephalopathy and prescribed lactulose (Cephulac). During morning report, the nurse learns that the previous nurse withheld the patient's latest dose of lactulose because the patient had two loose bowel movements during the shift. How should the nurse interpret the previous nurse's action? The previous nurse acted correctly because loose bowel movements present a threat to the patient's fluid and electrolyte balance. The previous nurse should have obtained an order for a stool softener to replace the scheduled lactulose. The previous nurse should have administered the lactulose because it is necessary to remove excess ammonia. The previous nurse should have administered a partial dose of the lactulose in spite of the patient's

The previous nurse should have administered the lactulose because it is necessary to remove excess ammonia. Medical management of hepatic encephalopathy focuses on identifying and correcting the precipitating cause if possible. Lactulose (Cephulac) is administered to reduce serum ammonia levels. Multiple loose bowel movements are expected, and the drug should not be withheld because of these.