NUR344 PrepU: Chapter 30 - Disorders of Hepatobiliary and Exocrine Pancreas Function

The health care provider has completed the assessment on a client with jaundice. The provider determines that which pathophysiologic abnormality could cause the jaundice?

Impaired uptake of bilirubin by the liver.

When caring for the client with Laennec's cirrhosis, the nurse recognizes which pathophysiologic finding to be an expected etiology of jaundice?

Impaired uptake of bilirubin.

During assessment of a recently admitted client with right-sided heart failure, the nurse notes that the liver is enlarged and verifies by palpation and percussion. A student asks the nurse to explain how the liver and heart failure are related. Which is the nurse's best response?

In right sided heart failure, there is high pressure in the inferior vena cava that backlogs blood into the liver.

The nurse is reviewing lab results of a client who has liver failure. The nurse determines that the client is at an increased risk for bleeding when the results include:

Increased prothrombin time.

The client in the GI clinic tells the nurse she is concerned she has something wrong with her gallbladder like what her friend with gallstones and inflammation had. Which of these complaints does the nurse recognize that supports the client's concern?

Intolerance to greasy food; burping.

A 40 year-old man who uses heroin intravenously was diagnosed with hepatitis C (HCV) one year ago and now has chronic viral hepatitis. Which of the following statements by the client to his care provider would warrant correction by the nurse?

It is at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms.

A client is prescribed erythromycin for an infection. What manifestations will the nurse recognize that indicate the onset of drug-induced cholestasis?

Jaundice and pruritus.

The liver has many jobs. One of the most important functions of the liver is to cleanse the portal blood of old and defective blood cells, bacteria in the bloodstream, and any foreign material. Which cells in the liver are capable of removing bacteria and foreign material from the portal blood?

Kuppffer cells.

Which client is most likely to develop hepatocellular cancer?

A client who has been diagnosed with metastatic breast cancer.

A 24-year-old woman undergoing a screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which treatment is most likely to be effective for her?

Corticosteroids and immunosuppressant drugs.

The nurse is caring for a client with hepatic encephalopathy who is receiving neomycin. Which of these does the nurse monitor to determine if a positive outcome to the medication has resulted?

Ammonia level.

When assessing the client with acute pancreatitis, which of these diagnostic tests, consistent with the disease, does the nurse anticipate will be altered?

Amylase and lipase.

The physician suspects a client may have developed pancreatitis, and the physician has ordered laboratory blood work. Diagnosis-confirming results would identify:

High serum amylase and lipase.

The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which of these complications?

Hyperglycemia due to inability to synthesize insulin.

When caring for the client with acute pancreatitis, which of these alterations does the nurse recognize is consistent with the disease?

Hyperglycemia.

The nurse is caring for the client with hepatocellular carcinoma. Which of these does the nurse recognize is a cause of this disease?

Illness with hepatitis B or C.

A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs, "more fluids in my vein?" The nurse responds:

"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."

The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points?

"Gallstones have developed, which are typically composed of cholesterol."

A 70 year-old male with a 40 pack-year history of smoking and longstanding non-insulin dependent diabetes has been diagnosed with pancreatic cancer. Which of the following teaching points should the physician provide?

"You will likely be facing surgery in the near future, but know that this is very unlikely to eliminate your cancer."

A client is admitted with the diagnosis of obstructive jaundice. Which assessment findings would the nurse expect to see in this client? Select all that apply.

-Clay-colored stools. -Dark urine. -Severe itching. -Elevated conjugated bilirubin levels.

The nurse is caring for a client with end-stage liver disease who is at risk for hepatic encephalopathy. For which complications that increase the risk for hepatic encephalopathy should the nurse assess? Select all that apply.

-Constipation. -Gastrointestinal bleeding. -High colonic pH.

Which situations would result in an increased intestinal production of ammonia in a client? Select all that apply.

-Ingested a high-protein lunch. -Was admitted with a gastrointestinal (GI) bleed.

The nurse is caring for a client with advanced cirrhosis who had a transjugular intrahepatic portosystemic shunt (TIPS) performed 3 months ago. Which assessments related to the client having a TIPS should the nurse prioritize? Select all that apply.

-Neurologic assessment. -Platelet level. -Hemoglobin level.

When educating the public about hepatitis A, the nurse will stress which accurate teaching points? Select all that apply.

-Persons working in various food industries like in a restaurant can pass on hepatitis A if they do not properly wash their hands after toilet. -Be careful if traveling to a foreign country since many countries do not require vaccination of their workers. -The onset of symptoms include high fever, malaise, abdominal pain, and jaundice.

While on tour, a 32 year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include temperature 46.8°C (101.8°F), blood pressure 89/48 mmHg and heart rate 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase and lipase are all elevated. Which of the following diagnoses would the care team suspect first?

Acute pancreatitis.

All diseases have risk factors. What is the most significant environmental risk factor for pancreatic cancer?

Cigarette smoking.

The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes which of these altered diagnostic tests is consistent with development of edema?

Decreased albumin.

A client newly diagnosed with pancreatic cancer is admitted to begin treatment. Which pain discriptors can be associated with adenocarcinomas of the pancreas?

Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward.

The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which of these ingested substances?

Fats.

A baby is born to a mother with active hepatitis B. Which of the following medications does the nurse anticipate administering today?

Hepatitis B immune globulin (HBIG).

A 29 year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What physiologic changes in the client's liver causing which of these altered diagnostic results does the nurse anticipate?

Hepatocellular necrosis evidenced by increased ALT and AST levels.

When educating a client who has been experiencing some manifestations of liver disease about the lab/diagnostic procedures available, which procedure provides the most information about abdominal masses and possible staging of a liver cancer?

Laparoscopic liver biopsy.

When caring for the client with portal hypertension and ascites, which of these dietary interventions does the nurse suggest to prevent the progression of fluid accumulation?

Limit intake of sodium.

The nurse is caring for a client with asterixis. Which of these additional assessments should the nurse make to help a diagnosis of hepatic encephalopathy?

Mental status.

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which of these descriptions?

Pain in the right upper quadrant referred to the same shoulder.

The nurse is caring for a client with viral hepatitis who has general malaise, easy fatigability, arthralgia, and anorexia. These manifestations correspond with what stage of the disease?

Prodromal period.

When teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition?

Progressive destruction of the organ.

The nurse is assessing a client who has just been admitted to the unit with a diagnosis of cholelithiasis. The nurse is aware that the client may manifest:

Right upper quadrant pain.

A client who has been diagnosed with acute symptomatic viral hepatitis is now in the icteric period. The nurse would expect the client to manifest:

Severe pruritus and liver tenderness.

A client has been diagnosed with choledocholithiasis and acute suppurative cholangitis, which have been determined to be a surgical emergency. Surgery must take place promptly because:

The accumulation of purulent bile can cause sepsis.

When explaining the role of liver Kupffer cells to a group of nursing students, which of the following statements about the function of these cells is most accurate?

The cells are capable of removing and phagocytizing old and defective blood cells.

A 51 year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse he does not understand what the liver does in the body. Which of these statements best explains the liver's function?

The liver metabolizes most components of food and also cleans the blood of bacteria and drugs.

When caring for a client with primary biliary cirrhosis, which of these statements by the nurse will best teach the client about the cause of this problem?

There is an autoimmune destruction of the bile ducts.

The community health nurse is teaching about prevention of hepatitis A. Which of these groups does the nurse suggest will benefit from this vaccine?

Those traveling to third world countries.

When assessing the client during the icteric phase of viral hepatitis, which of these findings does the nurse anticipate observing?

Yellow-tinged sclera.