Liver, Pancreas, & Biliary Tract Practice Problems

A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal

D. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM). Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A.

A 32-year-old patient is diagnosed with early alcoholic cirrhosis. Which topic is most important to include in patient teaching?

a. Need to abstain from alcohol The disease progression can be stopped or reversed by alcohol abstinence.

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

a. Schedule the patient for HCV genotype testing. Genotyping of HCV has an important role in managing treatment and is done before drug therapy is initiated.

A patient who has advanced cirrhosis is receiving lactulose (Cephulac). Which finding by the nurse indicates that the medication is effective?

a. The patient is alert and oriented. The purpose for lactulose in the patient with cirrhosis is to lower ammonia levels and prevent encephalopathy.

Which data obtained by the nurse during the assessment of a patient with cirrhosis will be of most concern?

a. The patient's hands flap back and forth when the arms are extended. The *asterixis* indicates that the patient has hepatic encephalopathy, and hepatic coma may occur.

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

b. Administer the spironolactone. Spironolactone is a potassium-sparing diuretic and will help to increase the patient's potassium level.

To evaluate the effectiveness of treatment for a patient who has hepatic encephalopathy, which action should the nurse take?

b. Ask the patient to extend both arms to the front. Extending the arms allows the nurse to check for *asterixis*, a classic sign of hepatic encephalopathy.

A homeless patient with severe anorexia and fatigue is admitted to the hospital with viral hepatitis. Which patient goal has the highest priority when the nurse is developing the plan of care?

b. Maintain adequate nutrition. The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration.

A patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which assessment finding is the best indicator that the medication has been effective?

b. Stools test negative for occult blood. Since the purpose of β-blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for propranolol is the lack of blood in the stools.

A patient is admitted to the hospital with acute cholecystitis. Which assessment information will be most important for the nurse to report to the health care provider?

b. The patient's stools are clay colored. The clay-colored stools indicate biliary obstruction, which requires rapid intervention to resolve.

When educating a patient with chronic pancreatitis about the prescribed pancrelipase (Viokase), the nurse will teach the patient to take the medication

b. with every meal. Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal.

A patient is admitted with an abrupt onset of jaundice, nausea, and abnormal liver function studies. Serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate?

c. "Do you use any over-the-counter (OTC) drugs?" The patient's symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms suggest toxic hepatitis, which can be caused by commonly used OTC drugs such as acetaminophen (Tylenol).

Which of these laboratory test results will be most important for the nurse to monitor when evaluating the effects of therapy for a patient who has acute pancreatitis?

c. Amylase Amylase is elevated in acute pancreatitis.

The health care provider plans a paracentesis for a patient with ascites caused by liver cancer. To prepare the patient for the procedure, the nurse

c. asks the patient to empty the bladder. The patient should empty the bladder to decrease the risk of bladder perforation during the procedure.

In planning care for a patient with acute severe pancreatitis, the nurse assigns the highest priority to the patient outcome of

c. maintenance of normal respiratory function. Respiratory failure can occur as a complication of acute pancreatitis, and maintenance of adequate respiratory function is the priority goal.

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

d. Abdominal pain is decreased. NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain.

After providing discharge instructions to a patient following a laparoscopic cholecystectomy, the nurse recognizes that teaching has been effective when the patient states,

a. "I can remove the bandages on my incisions tomorrow and take a shower." After a laparoscopic cholecystectomy, the patient will have Band-Aids in place over the incisions.

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

a. Monitor the patient for shortness of breath. The most common complication of balloon tamponade is aspiration pneumonia. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway.

When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about a history of

a. alcohol use. Alcohol use is one of the most common risk factors for pancreatitis in the United States.

When combination therapy of α-interferon and ribavirin (Rebetol) is being used to treat chronic hepatitis C, the nurse will plan to monitor for

a. leukopenia. Therapy with ribavirin and α-interferon may cause leukopenia. The other problems are not associated with this drug therapy.

Which of the following nursing actions included in the plan of care for a patient with cirrhosis can the RN delegate to nursing assistive personnel?

b. Providing oral hygiene before meals Providing oral hygiene is included in the education and scope of practice of nursing assistants.

A patient with severe cirrhosis has an episode of bleeding esophageal varices. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor

b. ammonia levels. The blood in the gastrointestinal (GI) tract will be absorbed as protein and may result in an increase in ammonia level because the liver cannot metabolize protein well.

The nurse determines that administration of hepatitis B vaccine to a patient has been effective when a specimen of the patient's blood reveals

b. anti-HBs. The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV.

The nurse is caring for a patient with chronic hepatitis C infection who has these medications prescribed. Which medication requires further discussion with the health care provider prior to administration?

b. pegylated α-interferon (PEG-Intron, Pegasys) SQ daily Pegylated α-interferon is administered weekly. The other medications are appropriate for a patient with chronic hepatitis C infection.

During change-of-shift report, the nurse learns about the following four patients. Which patient requires the most rapid assessment?

c. 45-year-old with cirrhosis and severe ascites who has an oral temperature of 102° F (38.8° C) This patient's history and fever suggest spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy.

A patient with cirrhosis who has been vomiting blood is admitted to the emergency department. Which action should the nurse take first?

c. Check BP, heart rate, and respirations. The nurse's first action should be to determine the patient's hemodynamic status by assessing vital signs.

When taking the BP of a patient with severe acute pancreatitis, the nurse notices carpal spasm of the patient's hand. Which action should the nurse take next?

c. Check the calcium level on the chart. The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau's sign.

After a patient has had a transjugular intrahepatic portosystemic shunt (TIPS) placement, which finding indicates that the procedure has been effective?

c. Decrease in episodes of variceal bleeding TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding from esophageal varices.

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

c. Review the patient's current medication list. Some medications can increase the risk for NAFLD and these should be eliminated.

When assessing a patient who had a liver transplant a week previously, the nurse obtains the following data. Which finding is most important to communicate to the health care provider?

c. Temperature 100.8° F (38.2° C) Infection risk is high in the first few months after liver transplant and fever is frequently the only sign of infection.

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

c. Use a pressure-relieving mattress. The pressure-relieving mattress will decrease the risk for skin breakdown for this patient.

Which nursing action is a priority when the nurse is caring for a patient with pancreatic cancer?

d. Administer prescribed opioids to relieve pain as needed. Effective pain management will be necessary in order for the patient to improve nutrition, be receptive to education, or manage anxiety or depression.

Which assessment finding in a patient with acute pancreatitis would the nurse need to report most quickly to the health care provider?

d. Muscle twitching and finger numbness Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered.

When the nurse is caring for a patient with acute pancreatitis, which assessment finding is of most concern?

d. Palpable abdominal mass A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis.

A patient who was admitted with acute bleeding from esophageal varices asks the nurse the purpose for the ordered ranitidine (Zantac). Which response by the nurse is most appropriate?

d. The medication will prevent irritation to the esophageal varices. The therapeutic action of H2 receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acid gastric contents.

Which information given by a patient when the nurse is taking a health history indicates that screening for hepatitis C should be done?

d. The patient reports a one-time use of IV drugs 20 years ago. Any patient with a history of IV drug use should be tested for hepatitis C.

A patient with cirrhosis has 4+ pitting edema of the feet and legs. The data indicate that it is most important for the nurse to monitor the patient's

d. albumin level. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema.

When a patient is diagnosed with acute hepatitis B, the nurse will plan to teach the patient about

d. measures that will be helpful in improving appetite. Maintaining adequate nutritional intake is important for regeneration of hepatocytes.

When caring for a patient following an incisional cholecystectomy for cholelithiasis, the nurse places the highest priority on assisting the patient to

d. turn, cough, and deep breathe every 2 hours. Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing.