Chapter 25: PrepU - Nursing Management: Patients With Hepatic and Biliary Disorders

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is: 1- acute cholecystitis 2- hepatitis A 3- hepatitis B 4- pancreatitis

1

A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan? 1- Increase respiratory effectiveness. 2- Eliminate the need for nasogastric intubation. 3- Improve nutritional status during recovery. 4- Decrease the amount of postoperative analgesia needed.

1

Which type of deficiency results in macrocytic anemia? 1- Folic acid 2- Vitamin C 3- Vitamin A 4- Vitamin K

1

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? 1- Potassium 2- Vitamin K 3- Vitamin B 4- Oral bile acids

2

After undergoing a liver biopsy, a client should be placed in which position? 1- Semi-Fowler's position 2- Right lateral decubitus position 3- Supine position 4- Prone position

2

A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations? 1- Hepatic encephalopathy 2- Esophageal varices 3- Hepatitis C 4- Portal hypertension

1

A client who was recently diagnosed with carcinoma of the pancreas and is having a procedure in which the head of the pancreas is removed. In addition, the surgeon will remove the duodenum and stomach, redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the middle section of the small intestine. What procedure is this client having performed? 1- radical pancreatoduodenectomy 2- cholecystojejunostomy 3- total pancreatectomy 4- distal pancreatectomy

1

A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? 1- Tetany related to hypocalcemia 2- Muscle spasm related to hypokalemia 3- Muscle pain related to referred pain manifestations 4- Tetany related to hypercalcemia

1

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? 1- Weight loss 2- Diarrhea 3- Fatigue 4- Hypertension

1

A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider? 1- tachycardia and tachypnea 2- tachycardia and bradypnea 3- bradycardia and bradypnea 4- bradycardia and tachypnea

1

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? 1- "How did this happen? I've been faithful my entire marriage." 2- "I'll be very careful when preparing food for my family." 3- "I'll wash my hands often." 4- "I'll take all my medications as ordered."

1

A nursing student has been assigned to care for a client with pancreatic cancer. The student is aware that the risk for pancreatic cancer is most directly proportional to 1- Age 2- Dietary intake of fat 3- Cigarette smoking 4- Presence of diabetes mellitus

1

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? 1- Risk for bleeding related to complications of liver failure 2- Knowledge deficit related to the causes of liver failure 3- Bowel incontinence related to treatments for liver failure 4- Risk for impaired gas exchange related to complications of liver failure

1

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? 1- decompression 2- instillation 3- gavage 4- lavage

1

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? 1- Choledochostomy 2- Cholecystostomy 3- Cholecystectomy 4- Choledochoduodenostomy

1

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: 1- The digestion of dietary and blood proteins. 2- Excessive diuresis and dehydration. 3- Severe infections and high fevers. 4- Excess potassium loss subsequent to prolonged use of diuretics.

1

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? 1- Providing intensive insulin therapy 2- Allowiing a clear liquid diet during the acute phase 3- Administering oral analgesics around the clock 4- Maintaining a high-Fowler's position

1

Clinical manifestations of common bile duct obstruction include all of the following except: 1- Amber-colored urine 2- Clay-colored feces 3- Pruritus 4- Jaundice

1

The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose? 1- Watery diarrhea 2- Vomiting 3- Ringing in the ears 4- Asterixis

1

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? 1- Assisting the client to turn, cough, and deep breathe every 2 hours 2- Teaching the client to choose low-fat foods from the menu 3- Performing range-of-motion (ROM) leg exercises hourly while the client is awake 4- Assisting the client to ambulate the evening of the operative day

1

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? 1- Respiratory assessment related to increased thoracic pressure 2- Urinary output related to increased sodium retention 3- Peripheral vascular assessment related to immobility 4- Skin assessment related to increase in bile salts

1

The nursing student has just reviewed material in the course textbook regarding pancreatitis. The student knows that a major symptom of pancreatitis that causes the client to seek medical care is: 1- Severe abdominal pain 2- Fever 3- Jaundice 4- Mental agitation

1

Which condition indicates an overdose of lactulose? 1- Watery diarrhea 2- Constipation 3- Hypoactive bowel sounds 4- Fecal impaction

1

Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses? 1- Ultrasonography 2- Magnetic resonance imaging 3- Angiography 4- Electroencephalogram

1

Which position should be used for a client undergoing a paracentesis? 1- Upright at the edge of the bed 2- Prone 3- Trendelenburg 4- Supine

1

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? 1- Hemolytic 2- Hepatocellular 3- Obstructive 4- Nonobstructive

1

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply. 1- fluid accumulation 2- venous pressure 3- blood coagulation 4- fluid output

1,2

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. 1- Insulin 2- Glucagon 3- Somatostatin 4- Lipase 5- Amylase

1,2,3

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply. 1- Jaundice 2- Petechiae 3- Ecchymoses 4- Cyanosis of the lips 5- Aphthous stomatitis

1,2,3

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? 1- High Fowler's positioning and fluid restriction 2- Low-sodium diet and administration of diuretics 3- Peritoneal massage and administration of hypertonic IV solutions 4- Low-protein diet and administration of IV albumin

2

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: 1- severe abdominal pain radiating to the shoulder. 2- anorexia, nausea, and vomiting. 3- eructation and constipation. 4- abdominal ascites.

2

A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide? 1- Normal activities may be resumed the day after surgery. 2- Normal activities may be resumed in 1 week. 3- Normal activities may be resumed in 2 weeks. 4- Normal activities may be resumed in 1 month.

2

A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor? 1- Elevated white blood cell count 2- Elevated alpha-fetoprotein 3- Decreased AST levels 4- Decreased alkaline phosphatase levels

2

A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? 1- Temperature 2- Albumin 3- Hemoglobin 4- Bilirubin

2

A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have? 1- Hypertension 2- Bile-stained vomiting 3- Warm, dry skin 4- Weight loss

2

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? 1- Vomiting after heavy meals 2- Skipping meals out of fear of painful attacks 3- Ingesting a low-fat diet to prevent abdominal pain 4- Malabsorption

2

A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority? 1- Developing no acute complications from the pancreatitis 2- Maintaining normal respiratory function 3- Maintaining satisfactory pain control 4- Achieving adequate fluid and electrolyte balance

2

A nursing instructor is lecturing to a class about chronic pancreatitis. Which of the following does the instructor list as major causes? 1- Malnutrition and acute pancreatitis 2- Alcohol consumption and smoking 3- Alcohol consumption and acute pancreatitis 4- Acute pancreatitis and alcohol consumption

2

A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is boardlike and no bowel sounds are detected. What is the major concern for this patient? 1- The patient requires more pain medication. 2- The patient is developing a paralytic ileus. 3- The patient has developed peritonitis. 4- The patient has developed renal failure.

2

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? 1- "You must have the second one in 2 weeks and the third in 1 month." 2- "You must have the second one in 1 month and the third in 6 months." 3- "You must have the second one in 6 months and the third in 1 year." 4- "You must have the second one in 1 year and the third the following year."

2

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? 1- Total bilirubin 2- AST/ALT ratio >3.0 3- Alkaline phosphatase 4- Albumin

2

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? 1- Administering an analgesic once per shift, as ordered, to prevent drug addiction 2- Positioning the client on the side with the knees flexed 3- Encouraging frequent visits from family and friends 4- Administering frequent oral feedings

2

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? 1- Weight loss of 2 pounds in 3 days 2- Change in the client's handwriting and/or cognitive performance 3- Anorexia for more than 3 days 4- Constipation for more than 2 days

2

Which is a clinical manifestation of cholelithiasis? 1- Epigastric distress before a meal 2- Clay-colored stools 3- Abdominal pain in the upper left quadrant 4- Nonpalpable abdominal mass

2

Which is the most common cause of esophageal varices? 1- Jaundice 2- Portal hypertension 3- Ascites 4- Asterixis

2

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? 1- Spironolactone 2- Vasopressin 3- Nitroglycerin 4- Cimetidine

2

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? 1- Appendicitis 2- Pancreatitis 3- Cholecystitis 4- Peptic ulcer

2

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy? 1- Increased motor activity 2- Asterixis 3- Negative Babinski reflex 4- Irritability

2

A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction? 1- Paracentesis 2- Liver transplantation 3- High-dose corticosteroids 4- Azathioprine

3

A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position? 1- On the left side 2- Trendelenburg 3- On the right side 4- High Fowler

3

A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority? 1- Fatigue 2- Excess fluid volume 3- Ineffective breathing pattern 4- Imbalanced nutrition: Less than body requirements

3

A client is diagnosed with gallstones in the bile ducts. The nurse knows to review the results of blood work for a 1- Serum ammonia concentration of 90 mg/dL 2- Serum albumin concentration of 4.0 g/dL 3- Serum bilirubin level greater than 1.0 mg/dL 4- Serum globulin concentration of 2.0 g/dL

3

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? 1- Placing the client in a semi-Fowler's position 2- Maintaining nothing-by-mouth (NPO) status 3- Administering morphine I.V. as ordered 4- Providing mouth care

3

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? 1- Cure the cirrhosis. 2- Treat the esophageal varices. 3- Reduce fluid accumulation and venous pressure. 4- Promote optimal neurologic function.

3

A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? 1- Chenodiol 2- Ursodiol 3- Tacrolimus 4- Interferon alfa-2b, recombinant

3

A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver? 1- Breakdown amino acids 2- Convert urea into ammonia 3- Excrete bile 4- Break down coagulation factors

3

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? 1- Straw-colored urine 2- Reduced hematocrit 3- Clay-colored stools 4- Elevated urobilinogen in the urine

3

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? 1- Hepatitis B is transmitted primarily by the oral-fecal route. 2- Hepatitis A is frequently spread by sexual contact. 3- Hepatitis C increases a person's risk for liver cancer. 4- Infection with hepatitis G is similar to hepatitis A.

3

A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review? 1- Serum ammonia concentration of 90 mg/dL 2- Serum albumin concentration of 4.0 g/dL 3- Serum bilirubin level greater than 1.0 mg/dL 4- Serum globulin concentration of 2.0 g/dL

3

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? 1- The patient will obtain measurement of drainage from the T-tube. 2- The patient will exercise three times a week. 3- The patient will take immunosuppressive agents as required. 4- The patient will monitor for signs of liver dysfunction.

3

A patient with portal hypertension has been admitted to the medical floor. What will the nurse assess for related to portal hypertension? 1- Bowel obstruction 2- Vitamin A deficiency 3- Ascites 4- Hepatic encephalopathy

3

Alcohol, which is toxic to the liver, is a common cause of hepatic disorders. As part of health teaching, the nurse advises a group of women that the amount of daily alcohol use should be limited to the equivalent of: 1- Two 12 oz bottles of beer. 2- One 6 oz martini. 3- Two 6 oz glasses of wine. 4- One 2 oz glass of a mixed drink (gin and tonic).

3

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? 1- To decrease metabolism 2- To depress the central nervous system and increase the pain threshold 3- To reduce gastric and pancreatic secretions 4- To relieve nausea and vomiting

3

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones? 1- 1 to 4 months 2- 4 to 6 months 3- 6 to 12 months 4- Over 1 year

3

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? 1- Magnetic resonance imaging 2- Angiography 3- Radioisotope liver scan 4- Electroencephalography

3

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? 1- Asterixis 2- Constructional apraxia 3- Fetor hepaticus 4- Palmar erythema

1

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease? 1- Pad the side rails on the bed 2- Apply soft wrist restraints 3- Raise all four side rails on the bed 4- Prevent visitors, so as not to agitate the client

1

What is the most appropriate nursing diagnosis for the client with acute pancreatitis? 1- Deficient fluid volume 2- Excess fluid volume 3- Decreased cardiac output 4- Ineffective gastrointestinal tissue perfusion

1

What is the recommended dietary treatment for a client with chronic cholecystitis? 1- low-fat diet 2- high-fiber diet 3- low-residue diet 4- low-protein diet

1

Which is an age-related change of the hepatobiliary system? 1- Increased drug clearance capability 2- Decreased blood flow 3- Enlarged liver 4- Decreased prevalence of gallstones

1

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? 1- Increased serum calcium levels 2- Elevated urine amylase levels 3- Decreased liver enzyme levels 4- Decreased white blood cell count

2

A client with calculi in the gallbladder is said to have 1- Cholecystitis 2- Cholelithiasis 3- Choledocholithiasis 4- Choledochotomy

2

Serologic testing of a middle-aged woman with a recent history of severe flu-like symptoms has just resulted in a diagnosis of hepatitis A. Which of the following assessment questions should the nurse prioritize when discussing this diagnosis with the patient? 1- "Are you currently in a monogamous sexual relationship?" 2- "How would describe your typical diet? 3- "Which restaurants have you eaten in over the past few weeks?" 4- "Have you ever used recreational drugs?"

3

The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? 1- Spironolactone 2- Cholestyramine 3- Lactulose 4- Kanamycin

3

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? 1- Dyspnea and fatigue 2- Ascites and orthopnea 3- Purpura and petechiae 4- Gynecomastia and testicular atrophy

3

hepatitis A

Ends in a vowel, comes from the bowel

S/S of peritonitis

abdominal rigidity caused by blood inside the tissue, Decrease bowel sounds

asterixis

aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.

Potassium-sparing diuretics such as spironolactone are used to treat

ascites

Cholestyramine

bile acid sequestrant

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? 1- Carbohydrate digestion 2- Protein synthesis 3- Fat digestion 4- Protein digestion

1

The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms? 1- Place the client in semi-Fowler's position. 2- Encourage the client to deep breathe and cough. 3- Instruct the client on the proper use of an incentive spirometer. 4- Encourage the client to ambulate frequently.

1

A 37-year-old male patient presents at the emergency department complaining of nausea and vomiting and severe abdominal pain. While the nurse is assessing the patient, the patient's wife informs the nurse that the patient ingested 24 ounces of vodka last evening. The patient's abdomen is rigid, and there is bruising to the patient's flank. What is the patient exhibiting signs of? 1- Pancreatitis with possible peritonitis 2- Acute cholecystitis 3- Obstruction of the bowel 4- Acute appendicitis

1

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? 1- Relieving abdominal pain 2- Preventing fluid volume overload 3- Maintaining adequate nutritional status 4- Teaching about the disease and its treatment

1

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? 1- ERCP 2- MRI 3- CT 4- Ultrasound

1

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status? 1- To drain the pancreatic bed 2- To aid opening up of pancreatic duct 3- To prevent the occurrence of fibrosis 4- To avoid inflammation of the pancreas

4

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? 1- Colonoscopy 2- Abdominal x-ray 3- Cholecystectomy 4- Endoscopic retrograde cholangiopancreatography (ERCP)

4

hepatocellular carcinoma

Cirrhotic liver (associated with hepatitis B and C and with alcoholism)

Constructional apraxia

The inability to reproduce geometric figures and designs. A person is often unable to visually analyze how to perform a task

cholelithiasis

gallstones in the gallbladder

Hepatitis C

inflammation of the liver caused by the hepatitis C virus (HCV), which is transmitted by exposure to infected blood; this strain is rarely contracted sexually

peritonitis

inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it)

Kanamycin decreases

intestinal bacteria and decreases ammonia but does not act as an osmotic agent.

Hepatic encephalopathy

liver coma, crazy movements, high amonia level, don't give protien

prodromal period

short period after incubation; early, mild symptoms

gastrectomy

surgical removal of part or all of the stomach

Fetor hepaticus

sweet, slightly fecal odor to the breath, presumed to be of intestinal origin; prevalent with the extensive collateral portal circulation in chronic liver disease

Esophageal varices

swollen, varicose veins at the lower end of the esophagus

A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to: 1- low platelet count. 2- low sodium level. 3- decreased prothrombin time. 4- low hemoglobin.

1

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? 1- Acute pain related to biliary spasms 2- Deficient knowledge related to prevention of disease recurrence 3- Anxiety related to unknown outcome of hospitalization I4- mbalanced nutrition: Less than body requirements related to biliary inflammation

1

A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam? 1- It visualizes the gallbladder and bile duct. 2- It visualizes the liver and pancreas. 3- It shows the sizes of the abdominal organs and detects any masses. 4- It visualizes the biliary structures and pancreas via endoscopy.

1

A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis? 1- A liver biopsy 2- A CT scan 3- A prothrombin time 4- Platelet count

1

A 33-year-old male patient with a history of IV heroin and cocaine use has been admitted to the medical unit for the treatment of endocarditis. The nurse should recognize that this patient is also likely to test positive for which of the following hepatitis viruses? 1- Hepatitis A 2- Hepatitis B 3- Hepatitis C 4- Hepatitis D

3

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? 1- Hepatic lobectomy 2- Radiotherapy 3- Liver transplantation 4- Laser ablation

3

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? 1- "The tube helps control fluid and electrolyte imbalance." 2- "The tube provides relief from nausea and vomiting." 3- "The tube allows the gastrointestinal tract to rest." 4- "The tube allows toxins to be removed."

3

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? 1- Monitor pulse oximetry every hour. 2- Withhold oral feedings for the client. 3- Instruct the client to avoid coughing. 4- Reposition the client every 2 hours.

4

A nurse is responsible for monitoring the diet of a client with hepatic encephalopathy. Which daily protein intake should this 185-pound (84-kilogram) male consume? 1- 16 to 49 grams 2- 50 to 75 grams 3- 76 to 99 grams 4- 100 to 126 grams

4

In what location would the nurse palpate for the liver? 1- Left lower quadrant 2- Left upper quadrant 3- Right lower quadrant 4- Right upper quadrant

4

The nurse is caring for a client with hepatitis. Which of the following would lead the nurse to suspect that the client is in the prodromal phase? 1- Jaundice 2- Clay-colored stools 3- Liver function tests approaching normal 4- Rash

4

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? 1- Jaundice 2- Pruritus of the arms and legs 3- Fatigue during ambulation 4- Irritability and drowsiness

4

paralytic ileus

complete absence of peristaltic movement that may follow abdominal surgery or complete bowel obstruction

vagotomy

cutting of certain branches of the vagus nerve, performed with gastric surgery to reduce the amount of gastric acid produced and thus reduce the recurrence of ulcers

Portal hypertension

the elevation of blood pressure within the portal venous system

bariatric

treatment of obesity

palmar erythema

unusual redness of the palms of the hands

cholecystogram

x-ray of the gallbladder