Exam 2 - Chapter 25 - Hepatic & Biliary Disorders

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the liklihood of liver problems? Select all that apply. Jaundice Petechiae Ecchymoses Cyanosis of the lips Aphthous stomatitis

Jaundice Petechiae Ecchymoses The skin, mucosa, and sclerae are inspected for jaundice. The nurse observes the skin for petechiae or ecchymotic areas (bruises), spider angiomas, and palmar erythema. Cyanosis of the lips is indicative of a problem with respiratory or cardiovascular dysfunction. Aphthous stomatitis is a term for mouth ulcers and is a gastrointestinal abnormal finding.

The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient? Respiratory assessment related to increased thoracic pressure Urinary output related to increased sodium retention Peripheral vascular assessment related to immobility Skin assessment related to increase in bile salts

Respiratory assessment related to increased thoracic pressure If a patient with ascites from liver dysfunction is hospitalized, nursing measures include assessment and documentation of intake and output (I&O;), abdominal girth, and daily weight to assess fluid status. The nurse also closely monitors the respiratory status because large volumes of ascites can compress the thoracic cavity and inhibit adequate lung expansion. The nurse monitors serum ammonia, creatinine, and electrolyte levels to assess electrolyte balance, response to therapy, and indications of encephalopathy.

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: The digestion of dietary and blood proteins. Excessive diuresis and dehydration. Severe infections and high fevers. Excess potassium loss subsequent to prolonged use of diuretics.

The digestion of dietary and blood proteins.

A client with a lengthy history of alcohol addiction is being seen for jaundice. The appearance of jaundice would most likely indicate: liver disorder. gallbladder disease. bile overproduction. glucose underproduction.

liver disorder.

The nurse is assessing a client admited with suspected pancreatitis. Which question will the nurse prioritize when assessing this client? "How many meals do you eat every day?" "How much alcohol do you consume in a day?" "When was the last time you took acetaminophen?" "How often and how long do you exercise each day?

"How much alcohol do you consume in a day?"

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? Constructional apraxia Fetor hepaticus Ataxia Asterixis

Asterixis

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

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 Vitamin B Oral bile acids

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.

Which condition indicates an overdose of lactulose? Watery diarrhea Constipation Hypoactive bowel sounds Fecal impaction

Watery diarrhea

Which is a clinical manifestation of cholelithiasis? Epigastric distress before a meal Clay-colored stools Abdominal pain in the upper left quadrant Nonpalpable abdominal mass

Clay-colored stools The client with gallstones has clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder. The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with bile pigments, are grayish (like putty) or clay colored. The client develops a fever and may have a palpable abdominal mass.

The nurse identifies a potential collaborative problem of electrolyte imbalance for a client with severe acute pancreatitis. Which assessment finding alerts the nurse to an electrolyte imbalance associated with acute pancreatitis? Muscle twitching and finger numbness Paralytic ileus and abdominal distention Hypotension Elevated blood glucose concentration

Muscle twitching and finger numbness Muscle twitching and finger numbness indicate hypocalcemia, a potential complication of acute pancreatitis. Calcium may be prescribed to prevent or treat tetany, which may result from calcium losses into retroperitoneal (peripancreatic) exudate. The other data indicate other complications of acute pancreatitis but are not indicators of electrolyte imbalance.

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis? Weight loss Diarrhea Fatigue Hypertension

Weight loss Weight loss is most common in the client with chronic pancreatitis due to decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. The other answer choices are not the most common complications related to chronic pancreatitis.

A patient has been admitted to the intensive care unit with a diagnosis of acute pancreatitis. Which of the following laboratory values will the nurse prioritize when gauging the course of his disease? Select all that apply. White blood cells (WBCs) Creatinine kinase Amylase Lipase Ammonia

White blood cells (WBCs) Amylase Lipase Serum amylase and lipase levels will be elevated to three times the upper limit of normal in most cases of acute pancreatitis. The WBC count is also usually elevated. Ammonia and creatinine kinase levels are not indicative of the diagnosis or trajectory of pancreatitis.

The nurse is caring for a client recovering from acute pancreatitis. Which menu item should the nurse remove from the client's breakfast tray? Toast Coffee Oatmeal Orange slices

Coffee Post-acute management of the client with acute pancreatitis includes the introduction of solid food. Oral feedings that are low in fat and protein are gradually initiated. Caffeine is eliminated from the diet and therefore coffee, which contains caffeine, should be removed from the client's breakfast tray. Even decaffeinated coffee has a small amount of caffeine but could serve as a compromise for chronic coffee drinkers. The other food items are appropriate for the client.

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? "How did this happen? I've been faithful my entire marriage." "I'll be very careful when preparing food for my family." "I'll wash my hands often." "I'll take all my medications as ordered."

"How did this happen? I've been faithful my entire marriage."

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? 1 to 4 months 4 to 6 months 6 to 12 months Over 1 year

6 to 12 months

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? Creatinine Urobilinogen Chloride Albumin

Albumin

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

Alcohol consumption and smoking

The nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. What will the nurse document this condition as in the patient's chart?. Asterixis Constructional apraxia Fetor hepaticus Palmar erythema

Asterixis The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating asterixis. Constructional apraxia is also a motor disturbance, but it is the inability to reproduce a simple figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath and not associated with a motor disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a reddening of the palms, but is not a flapping tremor.

A patient returns to the floor after a laparoscopic cholecystectomy. The nurse caring for the patient is aware that the most serious potential complication is what? Pulmonary atelectasis Decubitus ulcer Wound evisceration Bile duct injury

Bile duct injury

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired? Carbohydrate digestion Protein synthesis Fat digestion Protein digestion

Carbohydrate digestion

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 liver enzyme levels Decreased white blood cell count

Elevated urine amylase levels

The nurse is caring for a client suspected of having stones that have collected in the common bile duct. What test should the nurse prepare the client for that will locate these stones? Colonoscopy Abdominal x-ray Cholecystectomy Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP)

The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction? Hemolytic Hepatocellular Obstructive Nonobstructive

Hemolytic

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? Hemolytic Hepatocellular Obstructive Nonobstructive

Hemolytic

The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond? Low-sodium, high-potassium, low-fat diet High-carbohydrate, high-protein, low-fat diet Low-carbohydrate, high-potassium diet High-carbohydrate, low-protein, low-fat diet

High-carbohydrate, low-protein, low-fat diet The nurse should provide a high-carbohydrate, low-protein, low-fat diet when tolerated. These foods increase caloric intake without stimulating pancreatic secretions beyond the ability of the pancreas to respond.

Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? Hot roast beef sandwich with gravy Mashed potatoes White rice Vanilla pudding

Hot roast beef sandwich with gravy

A 59-year-old male patient was diagnosed with cirrhosis several years ago. After years of successful management of his chronic disease, he experienced a constellation of symptoms that eventually resulted in a diagnosis of hepatocellular carcinoma (HCC). What treatment holds the greatest potential for curing this patient's health problem? Hepatic lobectomy Radiotherapy Liver transplantation Laser ablation

Liver transplantation

The critical care nurse is caring for a patient with cirrhosis. What is a priority nursing function when caring for a patient with cirrhosis? Monitoring the patient's oral intake Monitoring the patient's social support network Monitoring the patient for signs of hypervolemia Monitoring the patient's mental status

Monitoring the patient's mental status Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patient's mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly. An extensive neurologic evaluation is key to identifying progression through the four stages of encephalopathy. The nurse would monitor the oral intake and watch for signs of hypervolemia, but they are not as essential as the patient's mental status because of the encephalopathy that goes with cirrhosis. Monitoring the support network is not essential at this time.

A critically ill client is diagnosed with acute liver failure caused by an overdose of acetaminophen. Which treatment will the nurse anticipate being prescribed for the client? Penicillin Prostaglandins N-acetylcysteine Plasma exchange

N-acetylcysteine

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

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.

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? Appendicitis Pancreatitis Cholecystitis Gastric ulcer

Pancreatitis Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. Appendicitis, cholecystitis, and gastric ulcer are less likely to exhibit fluid volume deficit.

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. A healthcare provider orders a liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. What should the nurse suspect? Peritonitis from bleeding in the liver caused by the liver biopsy Perforation of the colon caused by the liver biopsy An allergic reaction to the contrast media used during the liver biopsy Normal postprocedural pain, with a change in the level of consciousness resulting from the pre-existing fever

Peritonitis from bleeding in the liver caused by the liver biopsy

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? Magnetic resonance imaging Angiography Radioisotope liver scan Electroencephalography

Radioisotope liver scan

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? Decreased breath sounds Drainage of "bile-colored fluid" onto the abdominal dressing Rigidity of the abdomen Acute pain with movement

Rigidity of the abdomen

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? Serum calcium Serum bilirubin Serum amylase Serum potassium

Serum amylase

A client who has been having recurrent attacks of severe abdominal pain over the past few months informs the physician about a 25-pound weight loss in the past year. The nurse attributes which factor as the most likely cause of this weight loss? Vomiting after heavy meals Skipping meals out of fear of painful attacks Ingesting a low-fat diet to prevent abdominal pain Malabsorption

Skipping meals out of fear of painful attacks

A client is demonstrating symptoms of pancreatic cancer. Which diagnostic test will the nurse expect to be prescribed to prepare the client for surgery? Spiral computed tomography (CT) scan Endoscopic ultrasound Percutaneous transhepatic cholangiography Endoscopic retrograde cholangiopancreatogram

Spiral computed tomography (CT) scan Spiral (helical) computed tomography (CT) is more than 85% to 90% accurate in the diagnosis and staging of pancreatic cancer and currently is the most useful preoperative imaging technique. Endoscopic ultrasound is useful to identify small tumors and perform fine-needle biopsy of primary tumors or lymph nodes. Percutaneous transhepatic cholangiography may be used to identify obstructions of the biliary tract by a pancreatic tumor. Endoscopic retrograde cholangiopancreatogram (ERCP) may also be used in the diagnosis of pancreatic carcinoma. Cells obtained during ERCP are sent to the laboratory for analysis.

The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? Furosemide (Lasix) Spironolactone (Aldactone) Acetazolamide (Diamox) Bumetanide (Bumex)

Spironolactone (Aldactone) Potassium-sparing diuretic agents such as spironolactone or triamterene (Dyrenium) may be indicated to decrease ascites, if present; these diuretics are preferred because they minimize the fluid and electrolyte changes commonly seen with other agents.

A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? Tetany related to hypocalcemia Muscle spasm related to hypokalemia Muscle pain related to referred pain manifestations Tetany related to hypercalcemia

Tetany related to hypocalcemia A client with acute pancreatitis who reports muscle cramping or pain should be suspected of having hypocalcemia and tetany of the muscles. Hypocalcemia may occur in acute pancreatitis because, when auto digestion of the pancreas occurs, calcium binds to fatty acids and calcium is decreased in the blood. This is a potentially life-threatening complication of pancreatitis and needs to be immediately addressed.

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? To decrease metabolism To depress the central nervous system and increase the pain threshold To reduce gastric and pancreatic secretions To relieve nausea and vomiting

To reduce gastric and pancreatic secretions

Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses? Ultrasonography Magnetic resonance imaging Angiography Electroencephalogram

Ultrasonography A ultrasonography will show the size of the abdominal organs and the presence of masses. Magnetic resonance imaging is used to detect hepatic neoplasms. An angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. An electroencephalogram is used to detect abnormalities that occur with hepatic coma.

Which of the following is the most effective strategy to prevent hepatitis B infection? Vaccine Barrier protection during intercourse Covering open sores Avoid sharing toothbrushes

Vaccine The most effective strategy to prevent hepatitis B infection is through vaccination. Recommendations to prevent transmission of hepatitis B include vaccination of sexual contacts of individuals with chronic hepatitis, use of barrier protection during sexual intercourse, avoidance of sharing toothbrushes, razors with others, and covering open sores or skin lesions.

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? decompression instillation gavage lavage

decompression

When caring for a client with cirrhosis, which symptoms should a nurse report immediately? Select all that apply. change in mental status signs of GI bleeding anorexia and dyspepsia diarrhea or constipation

change in mental status signs of GI bleeding

A client who is 24 hours post op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms? "Apply a heating pad to your shoulder for 15 minutes hourly as needed." "Come into the emergency room as soon as possible." "Take an over the counter analgesic as needed." "Place your shoulder in a sling to avoid moving it."

"Apply a heating pad to your shoulder for 15 minutes hourly as needed." Pain in the right shoulder may occur after laparoscopic cholecystectomy due to migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure. The nurse should instruct the client to apply a heating pad to the shoulder for 15 to 20 minutes every hour as needed for pain relief. The nurse should not instruct the client to take analgesic medication-this is a medical order performed by the health care provider only. This scenario is not life threatening and the client does not need to go to the emergency department. It is also not necessary for the client to place the shoulder in a sling as this is not an injury-related condition.

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

"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.

A client with right upper quadrant pain and weight loss is diagnosed with liver cancer. For which treatment will the nurse prepare the client when it is determined that the disease is confined to one lobe of the liver? Radiation Liver resection Chemotherapy Laser hyperthermia

Liver resection

A 49-year-old man with a history of heavy alcohol use and liver cirrhosis has been admitted to the hospital's medical unit due to an exacerbation of his health problems that has resulted in massive ascites. The nurse should be prepared to implement which of the following interventions in an effort to resolve the patient's ascites? High Fowler's positioning and fluid restriction Low-sodium diet and administration of diuretics Peritoneal massage and administration of hypertonic IV solutions Low-protein diet and administration of IV albumin

Low-sodium diet and administration of diuretics

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis? Pain with abdominal distention and hypotension Presence of blood in the client's stool and recent hypertension Presence of easy bruising and bradycardia Adventitious breath sounds and hypertension

Pain with abdominal distention and hypotension

A nurse is gathering equipment and preparing to assist with a sterile bedside procedure to withdraw fluid from a client's abdomen. The procedure tray contains the following equipment: trocar, syringe, needles, and drainage tube. The client is placed in he high Fowler position and a blood pressure cuff is secured around the arm in preparation for which procedure? Liver biopsy Paracentesis Abdominal ultrasound Dialysis

Paracentesis

A patient has been admitted to the critical care unit from the subacute medical unit because his signs and symptoms of liver failure have become more pronounced over the past 24 hours. The critical care nurse who is planning this patient's care should prioritize which of the following nursing diagnoses? Risk for bleeding related to complications of liver failure Knowledge deficit related to the causes of liver failure Bowel incontinence related to treatments for liver failure Risk for impaired gas exchange related to complications of liver failure

Risk for bleeding related to complications of liver failure

Over the past 2 years, a 51-year-old man has been admitted to the hospital five times for problems related to alcohol abuse, including falls, acute alcohol withdrawal, and cirrhosis. The man's current admission has been precipitated by signs and symptoms of alcoholic liver disease (ALD). The care team is reasonably pleased with the patient's recovery to this point and discharge planning has begun. When organizing the patient's discharge planning, what psychosocial nursing diagnosis should be prioritized? Risk for altered family processes Risk for ineffective coping Risk for ineffective management of therapeutic regimen Risk for altered growth and development

Risk for ineffective management of therapeutic regimen

A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis? Fibrosis and atrophy of the pancreatic gland Calcification of the pancreatic duct, leading to its blockage Self-digestion of the pancreas by its own proteolytic enzymes Use of loop diuretics to increase the incidence of pancreatitis

Self-digestion of the pancreas by its own proteolytic enzymes

The nurse is planning the care of a patient who has a diagnosis of chronic pancreatitis. As part of this patient's early discharge planning, the nurse is identifying goals for self-care in collaboration with the patient. Which of the following goals is the most likely priority? The patient will plan a nutritionally balanced diet. The patient will abstain from drinking alcohol. The patient will demonstrate the correct technique for blood glucose testing. The patient will demonstrate aseptic technique of a dressing change.

The patient will abstain from drinking alcohol.

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 obtain measurement of drainage from the T-tube. The patient will exercise three times a week. The patient will take immunosuppressive agents as required. The patient will monitor for signs of liver dysfunction.

The patient will take immunosuppressive agents as required.

Which of the following diagnostic studies definitely confirms the presence of ascites? Ultrasound of liver and abdomen Abdominal x-ray Colonoscopy Computed tomography of abdomen

Ultrasound of liver and abdomen

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? Monitor pulse oximetry every hour. Withhold analgesics unless necessary. Instruct the client to cough only when necessary. Use incentive spirometry every hour.

Use incentive spirometry every hour.

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? Vitamin A Thiamine Riboflavin Vitamin K

Vitamin A

What is the recommended dietary treatment for a client with chronic cholecystitis? low-fat diet high-fiber diet low-residue diet low-protein diet

low-fat diet

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 remain on bed rest for several days." "I should wash the site with mild soap and water."

"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.

A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment? "The tube helps control fluid and electrolyte imbalance." "The tube provides relief from nausea and vomiting." "The tube allows the gastrointestinal tract to rest." "The tube allows toxins to be removed."

"The tube allows the gastrointestinal tract to rest."

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? Total bilirubin AST/ALT ratio >3.0 Alkaline phosphatase Albumin

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.

The single modality of pharmacologic therapy for chronic type B viral hepatitis is: Alpha-interferon Hepsera Epivir Baraclude

Alpha-interferon Alpha-interferon is a biologic response modifier that is highly effective for treatment

A client with calculi in the gallbladder is said to have Cholecystitis Cholelithiasis Choledocholithiasis Choledochotomy

Cholelithiasis

Which foods should be avoided following acute gallbladder inflammation? Cooked fruits Cheese Coffee Mashed potatoes

Cheese The client should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the client that fatty foods may induce an episode of cholecystitis. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-forming vegetables, bread, coffee, or tea may be consumed as tolerated.

A very ill client with acute cholecystitis is scheduled for surgery. The surgeon plans to create an incision in the common bile duct to remove stones. The nurse correctly documents this surgery in the electronic medical record using which term? Choledochostomy Cholecystostomy Cholecystectomy Choledochoduodenostomy

Choledochostomy This procedure is reserved for the client with acute cholecystitis who may be too ill to undergo a surgical procedure. It involves making an incision in the common duct, usually to remove stones (choledochostomy).

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? Straw-colored urine Reduced hematocrit Clay-colored stools Elevated urobilinogen in the urine

Clay-colored stools Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

A nurse cares for a client with a disorder of the endocrine function of the pancreas. Which hormones or enzymes may be impacted by this disorder? Select all that apply. Insulin Glucagon Somatostatin Lipase Amylase

Insulin Glucagon Somatostatin

Assessment data reveal a need to discuss nutrition with the client with cirrhosis. What is the nurse's priority intervention? Discuss meals that include high-carbohydrate with no protein restrictions. Discuss the importance of drinking at least 64 oz (1,893 ml) of water daily. Discuss meals that have a high-fiber, high-protein content. Discuss the importance of eliminating caffeine in the diet.

Discuss meals that include high-carbohydrate with no protein restrictions. In cirrhosis, the liver's metabolic function is compromised, increasing the client's need for high carbohydrates no protein restriction. A client with cirrhosis may have increased edema as a result of reduced plasma albumin, so he should restrict fluid intake rather than drink 64 oz of water daily. Increasing fiber intake isn't a priority intervention for a client with cirrhosis. A client with cirrhosis doesn't need to eliminate caffeine from his diet.

The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition? ERCP MRI CT Ultrasound

ERCP The ERCP is the most useful study in the diagnosis of chronic pancreatitis. The other answer choices may be used; however, these are not the most useful in the diagnosis of chronic pancreatitis.

Which is a gerontological consideration associated with the pancreas? Increased amount of fibrous material Increased bicarbonate output Increased rate of pancreatic secretion Increased calcium absorption

Increased amount of fibrous material An increase in fibrous material and some fatty deposition occurs in the normal pancreas of people older than 70 years of age. There is a decreased rate of pancreatic secretion and decreased bicarbonate output in older adults. Decreased calcium absorption may also occur.

A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal? Controlling bleeding Maintaining the airway Maintaining fluid volume Relieving the client's anxiety

Maintaining the airway

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN? Auscultate the abdomen for bowel sounds every 4 hours Measure abdominal girth every shift Monitor for reports of nausea and vomiting Measure blood glucose concentration every 4 to 6 hours

Measure blood glucose concentration every 4 to 6 hours

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.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? The client's hepatic function is decreasing. The client didn't take his morning dose of lactulose (Cephulac). The client is relaxed and not in pain. The client is avoiding the nurse.

The client's hepatic function is decreasing. The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? Riboflavin deficiency Folic acid deficiency Vitamin A deficiency Vitamin K deficiency

Vitamin K deficiency

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply. fluid accumulation venous pressure blood coagulation fluid output

fluid accumulation venous pressure

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: place the client in a private room. wear a mask when handling the client's bedpan. wash her hands after touching the client. wear a gown when providing personal care for the client.

wash her hands after touching the client. To maintain enteric precautions, the nurse must wash her hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.