liver, biliary, pancreas

A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies, but serologic testing is negative for viral causes of hepatitis. Which question would the nurse ask?

"Do you use any over-the-counter drugs?"

Which patient statement would indicate to the nurse that teaching after a laparoscopic cholecystectomy was effective?

"I can take a shower and walk around the house tomorrow."

A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective?

Abdominal pain is decreased

The nurse is caring for a patient with pancreatic cancer. Which nursing action would be the highest priority?

Administer prescribed opioids to relieve pain as needed

A patient has cirrhosis and 4+ pitting edema. Which focused data would the nurse assess?

Albumin level

Which topic would the nurse plan to teach the patient diagnosed with acute hepatitis B

Measures for improving appetite

Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis?

The patient is alert and oriented

Which information from a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C?

The patient used IV drugs about 30 years ago

The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?

The patient's hands flap back and forth when the arms are extended

Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis?

The patient's stools are tan colored

A patient had an incisional cholecystectomy 6 hours ago. Which action would the nurse identify as the highest priority for the patient to accomplish?

Turn, cough, and deep breathe every 2 hours

The nurse evaluates that administration of hepatitis B vaccine to a healthy patient was effective when the patient's later blood specimen reveals the presence of

anti-HBs

During change-of-shift report, the nurse learns about the following four patients. Which patient would the nurse assess first?

A patient with cirrhosis and ascites who has a temperature of 102F (38.8C)

Which risk factor would the nurse specifically ask about when a patient is being admitted with acute pancreatitis?

Alcohol use

Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis?

Lipase

A 26-yr-old patient who was admitted with viral hepatitis has severe anorexia and fatigue, and is homeless. Which goal has the highest priority in the plan of care?

Maintain adequate nutrition

The nurse is planning care for a patient with acute severe pancreatitis. Which outcome would the nurse identify as the highest priority?

Maintaining normal respiratory function

Which scheduling would the nurse teach a patient with chronic pancreatitis to use for the prescribed pancrelipase (Viokase)?

Mealtime

A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care?

Monitor the patient for shortness of breath

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis

Muscle twitching and finger numbness

Which assessment finding is of most concern for a patient with acute pancreatitis?

Palpable abdominal mass

A nurse is considering which patient to admit to the same room as a patient who is hospitalized with acute rejection 3 weeks after a liver transplant. Which patient would be the best choice?

Patient who requires pain management for chronic pancreatitis

A patient with chronic hepatitis B infection declines to take any medication that requires an injection. Which medication, if prescribed, requires further discussion with the health care provider?

Pegylated a-interferon (Pegasys)

A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care?

Place the patient on a pressure-relief mattress

When caring for a patient who has cirrhosis, which nursing action could the registered nurse (RN) delegate to assistive personnel (AP)?

Providing oral hygiene after a meal

A 36-yr-old female patient is receiving treatment for chronic hepatitis B with pegylated interferon (Pegasys). Which finding is important to communicate to the health care provider to suggest a change in therapy?

Report of severe depression

Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)?

Review the patient's current medication list.

Which action would the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B?

Schedule for liver cancer screening every 6 months.

A patient who has cirrhosis and esophageal varices is being treated with propranolol. Which finding is the best indicator to the nurse that the medication has been effective?

Stools test negative for occult blood

Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago?

Temperature 100.8F (38.2C)

Which response by the nurse best explains the purpose of propranolol for a patient who was admitted with bleeding esophageal varices?

The medication will prevent irritation of the enlarged veins

In reviewing the medical record for a patient admitted with acute pancreatitis, the nurse sees that the patient has a positive Cullen's sign. Indicate the area in the accompanying figure where the nurse will assess for this change.

3

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action would the nurse take?

Administer the spironolactone.

Which result is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices?

Ammonia levels

A young adult contracts hepatitis from contaminated food. Which result would the nurse expect serologic testing to reveal during the acute (icteric) phase of the patient's illness?

Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)

How would the nurse prepare a patient with ascites for paracentesis

Ask the patient to empty the bladder.

Which action would the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy?

Ask the patient to extend both arms forward

A patient born in 1955 had hepatitis A infection 1 year ago. Which action would the nurse include in care when the patient is seen for a routine annual physical examination?

Ask whether the patient has been screened for hepatitis C

A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider?

Asterixis and lethargy

Which topic is most important for the nurse to include in teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis?

Avoiding all alcohol use

Which action would the nurse in the emergency department take first for a patient who arrives vomiting blood?

Check blood pressure and heart rate

When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action would the nurse take next?

Check the calcium level in the health record

Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective?

Fewer episodes of bleeding varices

A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action would the nurse take?

Schedule the patient for HCV genotype testing