ch.43 liver, pancreas, and biliary tract problems

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

b.Avoiding alcohol ingestion The disease progression can be stopped or reversed by alcohol abstinence.

For a patient with cirrhosis, which of the following nursing actions can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)?

b.Providing oral hygiene after a meal Providing oral hygiene is within the scope of UAP.

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

b.The patient's stools are tan colored. Tan or grey stools indicate biliary obstruction, which requires rapid intervention to resolve.

Administration of hepatitis B vaccine to a healthy 18-year-old 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.

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

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

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

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

The nurse will ask a 64-year-old patient being admitted with acute pancreatitis specifically about a history of

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

A 24-year-old female 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 51-year-old woman had an incisional cholecystectomy 6 hours ago. The nurse will place 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.

After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take (select all that apply)?

a.Administer hepatitis B vaccine. b.Test for antibodies to hepatitis B. d.Give hepatitis B immune globulin.

A 23-year-old has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider?

a.Asterixis and lethargy The patient's findings of asterixis and lethargy are consistent with grade 2 hepatic encephalopathy.

A 36-year-old male 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.

Which finding indicates to the nurse that lactulose (Cephulac) is effective for a 72-year-old man who has advanced cirrhosis?

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

The nurse administering a-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for

a.leukopenia. Therapy with ribavirin and a-interferon may cause leukopenia.

The nurse is planning care for a 48-year-old woman with acute severe pancreatitis. The highest priority patient outcome is

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

A 55-year-old 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 by the nurse is most appropriate?

b."Do you use any over-the-counter 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 over-the-counter drugs such as acetaminophen (Tylenol).

The nurse recognizes that teaching a 44-year-old woman following a laparoscopic cholecystectomy has been effective when the patient states which of the following?

b."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.

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 should the nurse take?

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

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

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

Which goal has the highest priority in the plan of care for a 26-year-old homeless patient admitted with viral hepatitis who has severe anorexia and fatigue?

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

A 53-year-old patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care?

b.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.

A 34-year old patient with chronic hepatitis C infection has several medications prescribed. Which medication requires further discussion with the health care provider before administration?

b.Pegylated a-interferon (PEG-Intron, Pegasys) SQ daily Pegylated a-interferon is administered weekly.

A 36-year-old female patient is receiving treatment for chronic hepatitis C with pegylated interferon (PEG-Intron, Pegasys), ribavirin (Rebetol), and telaprevir (Incivek). Which finding is most important to communicate to the health care provider?

b.Positive urine pregnancy test Because ribavirin is teratogenic, the medication will need to be discontinued immediately.

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

b.Schedule for liver cancer screening every 6 months. Patients with chronic hepatitis are at higher risk for development of liver cancer, and should be screened for liver cancer every 6 to 12 months.

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

b.The patient used IV drugs about 20 years ago. Any patient with a history of IV drug use should be tested for hepatitis C.

The nurse is caring for a 73-year-old man who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?

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

To detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices, it is most important for the nurse to monitor

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

The nurse will plan to teach the patient diagnosed with acute hepatitis B about

b.measures for improving the appetite. Maintaining adequate nutritional intake is important for regeneration of hepatocytes

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

c.55-year-old with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C) This patient's history and fever suggest possible spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy.

The nurse is caring for a 36-year-old patient with pancreatic cancer. Which nursing action is the highest priority?

c.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 teaching, or manage anxiety or depression.

Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a 62-year-old female patient who has acute pancreatitis?

c.Amylase Amylase is elevated in acute pancreatitis.

A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical exam?

c.Ask whether the patient has been screened for hepatitis C. Current CDC guidelines indicate that all patients who were born between 1945 and 1965 should be screened for hepatitis C because many individuals who are positive have not been diagnosed.

Which action should the nurse in the emergency department take first for a new patient who is vomiting blood?

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

A 38-year-old patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care?

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

A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator that the medication has been effective?

c.Stools test negative for occult blood. Because the purpose of b-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.

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?

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

Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient admitted with bleeding esophageal varices?

c.The medication will prevent irritation of the enlarged veins. Esophageal varices are dilated submucosal veins.

To prepare a 56-year-old male patient with ascites for paracentesis, 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.

The nurse will teach a patient with chronic pancreatitis to take the prescribed pancrelipase (Viokase)

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

A 67-year-old male 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.

Which data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis?

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

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

d.Fewer episodes of bleeding varices TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding from esophageal varices. Indirect bilirubin level and serum albumin levels are not affected by shunting procedures.

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

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

Which assessment finding is of most concern for a 46-year-old woman with acute pancreatitis?

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

d.Patient who requires pain management for chronic pancreatitis The patient with chronic pancreatitis does not present an infection risk to the immunosuppressed patient who had a liver transplant.