Chapter 30 Application Based Questions: Disorders of Hepatobiliary and Exocrine Pancreas Function

All diseases have risk factors. What is the most significant environmental risk factor for pancreatic cancer? -Air pollution -Water pollution -Cigarette smoking -Heavy metal toxicity

-Cigarette smoking

A health care provider suspects a client may have developed pancreatitis. Which laboratory value will confirm this diagnosis?

High serum amylase and lipase

The nurse is caring for a client with right upper quadrant pain secondary to acute choledocholithiasis. If the common bile duct becomes obstructed, which manifestation will the nurse expect? -Ascites -Vomiting -Hyperbilirubinemia -Hemorrhage

Hyperbilirubinemia

When caring for the client with acute pancreatitis, which alterations does the nurse recognize is consistent with the disease? -Hypertension -Hyperglycemia -Leukopenia -Polyuria

Hyperglycemia

A nurse is reviewing laboratory results of a client with impaired liver function and anticipating which abnormal result indicating injury to liver cells? -Liver enzymes -Plasma proteins -Blood clotting factors -Serum bilirubin

Liver enzymes

The nurse is teaching a client about surgical treatments available for chronic viral hepatitis. Which of these is appropriate for the nurse to relate? -Hepatectomy -Removal of the diseased portion of the liver -Liver transplant -Portosystemic shunt

Liver transplant

The nurse is caring for a client with asterixis. Which assessment should the nurse make to help a diagnosis of hepatic encephalopathy? -Mental status -Vital signs -Prothrombin time -Serum albumin

Mental status

A client has been diagnosed with cholelithiasis. The nurse is aware the client is at risk for developing which manifestations? Select all that apply. -Obstruction of bile flow -Biliary colic -Acute cholecystitis -Chronic cholecystitis -Absence of vitamin B12

-Obstruction of bile flow -Biliary colic -Acute cholecystitis -Chronic cholecystitis

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 -Elevated conjugated bilirubin levels -Decreased serum alkaline phosphatase levels -Severe itching

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

A baby is born to a mother with active hepatitis B. Which medication does the nurse anticipate administering today? -Tenofovir disoproxil fumarate plus emtricitabine -Hepatitis B immune globulin (HBIG). -Hepatitis C immune globulin (HCIG). -Hepatitis A vaccine (HAV).

-Hepatitis B immune globulin (HBIG).

While teaching a family member about the development of hepatic encephalopathy, which cause is likely to be mentioned? -Hypersplenism -High sodium level in foods and beverages -Neurotoxin accumulation -Steroid hormone deficiency

-Neurotoxin accumulation

The nurse is assessing a client with a history of long-term alcohol use for signs and symptoms of early cirrhosis. Which question by the nurse will help elicit these early symptoms? -"Do you find your appetite is poor lately?" -"Do your legs swell when you walk for long periods?" -"Is there discomfort in your left upper abdomen? -"Has anyone told you that you have high blood pressure?"

"Do you find your appetite is poor lately?"

The nurse is caring for a client with a diagnosis of post-hepatic obstruction. Which of these questions will assist the nurse in determining the underlying cause of the obstruction? -"Do you drink alcohol?" -"Have you had a recent blood transfusion?" -"Have you been told you have had gallstones?" -"Have you had yellow skin?"

"Have you been told you have had gallstones?"

Antibody testing has confirmed that a client is positive for hepatitis A virus (HAV). Which statement suggests the client understands the new diagnosis? -"I guess I'm an example of why you should always use condoms." -"I'm embarrassed that I'll be a carrier of hepatitis from now on." -"I'm still trying to deal with the fact that this will forever change my life." -"I don't know why I didn't bother to get vaccinated against this."

"I don't know why I didn't bother to get vaccinated against this."

For several years, a single mother of 2 has been averaging 2 to 3 bottles of wine each night and recently has added several ounces of brandy as well. She now has been diagnosed with cirrhosis. Which physical manifestations of cirrhosis would the nurse expect to find during assessment? Select all that apply. -Ascites -Anorexia -Fever -Bleeding tendencies -Epigastric pain -Obesity

-Ascites -Anorexia -Bleeding tendencies -Epigastric pain

Following several days of intermittent upper right quadrant pain, a 29-year-old obese, Native American/First Nation woman has been diagnosed with cholelithiasis. The nurse at the clinic has taught the client about the pathophysiology and contributing factors to her health problem, as well as some of the likely treatment options. Which statement by the client demonstrates a sound understanding of her diagnosis? -"All in all, I guess this is a result of the fact that I've been eating a diet too high in cholesterol for too long." -"Several factors like my genetics and gender may have contributed to this, but I'm glad that medications can cure it." -"This explains why my skin was yellow-tinged lately and why I had those pains that spread to my upper back and right shoulder." -"I suppose the fever and vomiting I had this week was probably a sign of my gallstones too."

"This explains why my skin was yellow-tinged lately and why I had those pains that spread to my upper back and right shoulder."

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 teaching points should the physician provide? -"While this is indeed serious, you should know that you have a good chance of beating this disease with appropriate treatment." -"Most likely your pattern of high alcohol intake over the years contributed to your cancer." -"You will likely be facing surgery in the near future, but know that this is very unlikely to eliminate your cancer." -"I know it may seem trivial at this point, but the levels of pain that accompany cancer of the pancreas are normally quite low."

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

A client is experiencing hepatorenal syndrome. Which manifestations will the nurse assess in this client? Select all that apply. -Azotemia -Increased serum creatinine -Oliguria -Ascites -Polyuria

-Azotemia -Increased serum creatinine -Oliguria -Ascites

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 will stay in your blood vessels a long time so that you will not seep out more fluid in your belly for at least a few weeks." -"Albumin works like your diuretics to help you get rid of excess fluid through your kidneys. It's just more potent than your home water pills." -"After the albumin, your potassium level will stay steady and you should keep excess water weight off for several weeks." -"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."

-"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? -"You have an inflammation of your gallbladder caused by an autoimmune process." -"Gallstones have developed, which are typically composed of cholesterol." -"You are unable to store bile in your gallbladder, which inhibits digestion of the foods you eat." -"Stones in the gallbladder are most common in men. Your case is unusual."

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

A 51-year-old male professional is in the habit of consuming 6 to 8 rum and Cokes each evening after work. He assures the nurse practitioner who is performing his regular physical exam that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the client's statement? -"You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking." -"That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer." -"In spite of that, the amount of alcohol you are drinking is likely to result first in cirrhosis and, if you continue, in hepatitis or fatty liver changes." -"When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic by-products."

-"When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic by-products."

A male infant who is 48 hours postpartum is undergoing phototherapy for the treatment of jaundice and accompanying high levels of bilirubin. Place the following components of the production of bilirubin in the correct chronological order. Use all the options. a. Red blood cells b. Biliverdin c. Free bilirubin d. Conjugated bilirubin e. Urobilinogen -1d, 2e, 3a, 4b, 5c -1a, 2b, 3c, 4d, 5e -1b, 2a, 3c, 4d, 5e -1a, 2b, 3e, 4c, 5d -1a, 2b, 3e, 4d, 5c

-1a, 2b, 3c, 4d, 5e

A client with multiple pain-related injuries to the back, knees, and hips is admitted with acute liver failure. Upon procuring a medication list, the nurse notes that the client is taking several over-the-counter medications that contain a preparation known to be the drug that most commonly causes liver failure. Which drug is this? -Aspirin -Acetaminophen -Ibuprofen -Phenylephrine

-Acetaminophen

When planning care for the client with hemorrhage related to esophageal varices, the nurse anticipates which measure will be used to control bleeding? Select all that apply. -Insertion of a urinary catheter -Administration of octreotide -Balloon tamponade -Coronary artery bypass grafting -Use of propranolol

-Administration of octreotide -Balloon tamponade

The oncology nurse is teaching a group of nursing students about risk factors for pancreatic cancer. Which factors does the nurse include in the teaching session? Select all that apply. -Colon cancer -Hypertension -Age over 50 years -Chronic pancreatitis -Cigarette smoking

-Age over 50 years -Chronic pancreatitis -Cigarette smoking

A man with a history of excess alcohol consumption for 25 years is admitted with cirrhotic liver disease. To assess the amount of damage to the liver, which lab tests of hepatobiliary function should be monitored? Select all that apply. -Creatinine -Alanine aminotransferase (ALT) -Troponin -gamma-glutamyl transferase (GGT) -Aspartate aminotransferase (AST)

-Alanine aminotransferase (ALT) -gamma-glutamyl transferase (GGT) -Aspartate aminotransferase (AST)

The nurse is teaching a group of nursing students about hepatitis. What causes of hepatitis would the nurse teach the client about? Select all that apply. -Unrefrigerated foods -Alcohol consumption -Diabetes -Viruses -Autoimmune disorders

-Alcohol consumption -Viruses -Autoimmune disorders

A client with history of alcohol abuse is brought to the emergency department after a weekend of heavy drinking, experiencing right upper quadrant pain, anorexia, nausea, jaundice and ascites. The nurse identifies these as manifestations of what disorder? -Fatty liver -Alcoholic hepatitis -Cancer of the gallbladder -Cholestasis

-Alcoholic hepatitis

When assessing the client with acute pancreatitis, which of these diagnostic tests—consistent with the disease— does the nurse anticipate will be altered? -The transaminases -Creatine kinase -Amylase and lipase -Glucose values

-Amylase and lipase

A client with chronic hepatitis B is undergoing diagnostic testing for possible liver cancer. The nurse can correlate which clinical manifestations with development of liver cancer? Select all that apply. -Client reports "abdominal fullness and bloating." -Client states, "My abdomen is getting larger and I can no longer get my belt buckled." -Client reports that "blood sugar has been higher than normal all week." -Client states, "I feel like my head is pounding all the time." -Client reports "skin is crawling with bugs."

-Client reports "abdominal fullness and bloating." -Client states, "My abdomen is getting larger and I can no longer get my belt buckled."

A 24-year-old woman undergoing a premarital 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? -Lamivudine -Peginterferon and ribavirin -Interferon-alfa-2b -Corticosteroids and immunosuppressant drugs

-Corticosteroids and immunosuppressant drugs

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? -Lamivudine -Pegylated interferon and ribavirin -Interferon alfa-2b -Corticosteroids and immunosuppressant drugs

-Corticosteroids and immunosuppressant drugs

The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes that which altered diagnostic test is consistent with development of edema? -Elevated cholesterol -Decreased prothrombin -Decreased albumin -Elevated ammonia

-Decreased albumin

When providing care for the client with pancreatic cancer, the nurse should observe for which of these complications? -Fluid volume excess -Hyperventilation -Hypoglycemia -Deep vein thrombosis

-Deep vein thrombosis

A client newly diagnosed with pancreatic cancer is admitted to begin treatment. Which pain descriptors can be associated with adenocarcinomas of the pancreas? -Sharp, stabbing pain with each deep breath. -Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward. -Abdominal pain following the ingestion of a large meal heavy with fat and protein. -Severe, intractable headache caused by excess fluid in the CNS causing cerebral edema.

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

Clients with chronic autoimmune hepatitis may display which clinical manifestations upon physical exam? Select all that apply. -Enlarged liver -Jaundice -Bacterial meningitis -Nuchal rigidity -Edematous joints

-Enlarged liver -Jaundice

A client had developed jaundice. The nurse recognizes that the jaundice may have resulted from which cause? Select all that apply. -Excessive destruction of red blood cells -Impaired uptake of bilirubin by the liver cells -Decreased conjugation of bilirubin -Obstruction of bile flow -Decreased production of bile -Impaired production of red blood cells

-Excessive destruction of red blood cells -Impaired uptake of bilirubin by the liver cells -Decreased conjugation of bilirubin -Obstruction of bile flow

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 ingested substance? -Protein -Fats -Carbohydrates -Amino acids

-Fats

The nurse at a clinic reviews client histories to determine if the hepatitis B vaccine should be given. Which clients should receive the vaccine? Select all that apply. -Male in a long-term, mutually monogamous relationship -Female surgical scrub technician -Female with hepatitis B infection 2 years ago -Male with HIV infection -Female newborn whose mother has hepatitis B virus -Male soldier posted to the Middle East

-Female surgical scrub technician -Male with HIV infection -Female newborn whose mother has hepatitis B virus -Male soldier posted to the Middle East

A teenager has been admitted to the emergency department after ingesting 20 g of acetaminophen in a suicide attempt. The nursing team recognizes this client is at risk for acute fulminant hepatitis, with elevated ammonia levels that can be detected by assessing for which manifestations? Select all that apply. -Flapping tremor (asterixis) -Confusion -Convulsions -Elevated creatinine levels -Photosensitivity

-Flapping tremor (asterixis) -Confusion -Convulsions

The nurse is assessing a client with acute pancreatitis who denies use of alcohol. When teaching the client about additional causes of acute pancreatitis, the nurse includes which of these in the discussion? Select all that apply. -Gallstones -Hypocalcemia -Increased cholesterol -Potassium-sparing diuretics -Abdominal trauma

-Gallstones -Increased cholesterol -Abdominal trauma

An ultrasound of a client with intermittent pain reveals gallbladder sludge. Which client history items are likely factors in the ultrasound result? Select all that apply. -Had lap band surgery 2 years ago and lost 100 pounds -Recent pregnancy with a 6-month-old child at home -Current prescription for a medicine to lower cholesterol -A runner training for a marathon -Works in surgery with long periods of standing in one place

-Had lap band surgery 2 years ago and lost 100 pounds -Recent pregnancy with a 6-month-old child at home -Current prescription for a medicine to lower cholesterol

A client with ascites suddenly develops a change in mental status, elevated neutrophil count, and abdominal pain. Which additional complications should the nurse monitor the client for? Select all that apply. -Hepatic encephalopathy -Peripheral edema -Shock -Fever -Diarrhea

-Hepatic encephalopathy -Shock -Diarrhea

Which diagnosis causes an increased risk of developing intrahepatic jaundice? Select all that apply. -Hepatitis -Cirrhosis -Liver cancer -Cholelithiasis -Bile duct malformation

-Hepatitis -Cirrhosis -Liver cancer

A client tells the nurse that he is concerned about developing hepatitis after being exposed to contaminated feces, saliva, and food. The nurse is aware that the client is at risk for: -Hepatitis A -Hepatitis B -Hepatitis C -Hepatitis D

-Hepatitis A

A client is admitted with late manifestations of cirrhosis. Which clinical manifestations confirm this diagnosis? Select all that apply. -Hepatomegaly felt on deep palpation -Diffuse liver fibrosis with large, palpable lumps -GI bleeding related to esophageal varices -Acute renal failure with electrolyte imbalances -Splenomegaly with bleeding tendencies

-Hepatomegaly felt on deep palpation -GI bleeding related to esophageal varices -Splenomegaly with bleeding tendencies

A neonate is undergoing phototherapy for the treatment of jaundice and accompanying high levels of bilirubin. Which causes are the likely factors responsible for neonatal hyperbilirubinemia? Select all that apply. -Concentration of maternal bilirubin -High bilirubin production -Increased lysis of red blood cells -Neonatal cholestasis -Limited ability to excrete bilirubin

-High bilirubin production -Limited ability to excrete bilirubin

The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which complication? -Hyperglycemia due to inability to synthesize insulin -Nutritional imbalance due to inability to synthesize protein -Bleeding related to lack of clotting factors -Gallstones related to inability to digest fat

-Hyperglycemia due to inability to synthesize insulin

The nurse is caring for the client with hepatocellular carcinoma. What does the nurse recognize is a cause of this disease? -Exposure to nonsteroidal anti-inflammatory medications -Illness with hepatitis B or C -Gallbladder disease -Diabetes

-Illness with hepatitis B or C

When caring for the client with Laennec cirrhosis, the nurse recognizes which pathophysiologic finding to be an expected etiology of jaundice? -Impaired uptake of bilirubin -Decreased oxygen at birth -Increased red cell development -Increased conjugation of bilirubin

-Impaired uptake of bilirubin

The nurse is reviewing laboratory results of a client who has liver failure. Which finding would place the client at increased risk for bleeding? -Increased prothrombin time -Increased levels of vitamin K -Decreased number of red blood cells -Increased platelet count

-Increased prothrombin time

When caring for the client with hepatic failure, the nurse recognizes that which problem places the client at increased risk for bleeding? -Increased prothrombin time -Increased vitamin K -Decreased red blood cells -Increased platelet count

-Increased prothrombin time

Which situations would result in an increased intestinal production of ammonia in a client? Select all that apply. -Ingested a high-protein lunch. -Consumes a large amount of acidic tomatoes for supper. -Was admitted with a gastrointestinal (GI) bleed. -Consumes large amounts of ice cream and yogurt daily. -Avoids all meat products.

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

The nurse recognizes that which individuals are at risk for hepatitis B? Select all that apply. -Those with cirrhosis -Injection drug users -Blood donors -Those who eat sushi -Those having unprotected sex

-Injection drug users -Those having unprotected sex

A client is concerned about acquiring hepatitis A and asks the nurse who should receive the HAV vaccine. Which responses by the nurse are accurate? Select all that apply. -International travelers visiting to regions where sanitation is poor -Sexually active gay men -Users of illicit drugs -Workers employed in food handling -Children living in communities with low rates of HAV infection

-International travelers visiting to regions where sanitation is poor -Sexually active gay men -Users of illicit drugs -Workers employed in food handling

A client with hepatitis B asks the nurse, "How did I get this hepatitis?" Which responses are most accurate regarding the mode of transmission for hepatitis B? Select all that apply. -Intravenous drug use -Fecal-oral route -Unprotected sexual intercourse -Sharing oral secretions by kissing -Inhalation of airborne droplets

-Intravenous drug use -Unprotected sexual intercourse

A 40-year-old man who uses heroin intravenously was diagnosed with hepatitis C (HCV) 1 year ago and now has chronic viral hepatitis. Which statement by the client to his care provider would warrant correction by the nurse? -I know the medications to treat this aren't fantastic, but at least there are some options for controlling the virus. -It is at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms. -Even though I'm sick, at least I won't feel sick most of the time. -I'm not looking forward to all the side effects of the drug treatments for my HCV, but I hope I don't end up needing a liver transplant.

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

The nurse is caring for a client with an elevated serum bilirubin level. The nurse recognizes a high bilirubin level may result in which condition? -Jaundice -Cholestasis -Xanthomas -Biliary cirrhosis

-Jaundice

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? -Kupffer cells -Langerhans cells -Epstein cells -Davidoff cells

-Kupffer cells

The nurse is assessing a client exposed to viral hepatitis who is thought to be in the prodromal phase. When assessing the client, which symptoms does the nurse recognize are consistent with this phase? Select all that apply. -Lack of appetite -Lack of energy -Jaundice -Myalgia -Right upper quadrant tenderness

-Lack of appetite -Lack of energy -Myalgia

What laboratory markers are most commonly used to diagnose acute pancreatitis? -Amylase and cholesterol -Lipase and amylase -Lipase and triglycerides -Cholesterol and triglycerides

-Lipase and amylase

When caring for clients with alcoholism and cirrhosis, which the nurse recognizes which potential complications of the disease? Select all that apply. -Liver failure -Bleeding esophageal varices -Kidney failure -Alcohol poisoning -Trauma from alcohol-induced accidents

-Liver failure -Bleeding esophageal varices -Kidney failure

A client is suspected of having liver cancer. Which diagnostic test would be ordered to confirm the diagnosis? -Serum alpha-fetoprotein -Endoscopy -Ultrasound of the liver -MRI of the liver

-MRI of the liver

A client has been admitted with hepatocellular jaundice as a result of taking medications. From the following list of medications in the client's home, which medications may place the client at high risk for developing hepatocellular jaundice? Select all that apply. -Oral contraceptives for birth control -Nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain -Anabolic steroids taken for body building -Isoniazid for tuberculosis -Ciprofloxacin for recurrent sinus infection.

-Oral contraceptives for birth control -Anabolic steroids taken for body building -Isoniazid for tuberculosis

Following a needlestick injury, a nurse develops hepatitis C that eventually developed into a chronic infection. The health care provider counsels the nurse to assess for which major complications that can result from this chronic condition? Select all that apply. -Chronic anemia -Progressive liver fibrosis -Septicemia -Liver cancer -Biliary stone formation

-Progressive liver fibrosis -Liver cancer

A client is suspected of having the onset of alcoholic liver disease. The nurse should be assessing for which manifestation related to the necrosis of liver cells? -Tremors of the hands -Rapid onset of jaundice -Long muscle group atrophy -Development of multiple skin nodules

-Rapid onset of jaundice

The nurse is performing physical assessment of the gastrointestinal tract. In which area does the nurse place the hands for palpation of the liver? -Right upper quadrant -Left upper quadrant -Right lower quadrant -Left upper quadrant

-Right upper quadrant

The nurse teaches the client that which of these contributed to the development of acute cholelithiasis? -Chronic pancreatitis -Rapid elimination of bile -Stasis of bile -Excessive alcohol consumption

-Stasis of bile

While caring for a client undergoing diagnostic testing for possible liver failure, the nurse asks the student nurse what clinical manifestations of liver failure she should assess for. Which answers are accurate? Select all that apply. -Sweet, musty breath. -Palpable masses located in liver region of the abdomen -Dull, epigastric pain accompanied by back pain -Multiple bruising noted on body -Abdominal peritonitis

-Sweet, musty breath. -Multiple bruising noted on body

A client presents to the emergency department with suspected pancreatitis. Which manifestations would the nurse assess in this client? Select all that apply. -Tachycardia -Fever -Tenderness -Epigastric pain -Hypertension -Increased urinary output

-Tachycardia -Fever -Tenderness -Epigastric pain

When explaining the role of liver Kupffer cells to a group of nursing students, which statement about the function of these cells is most accurate? -The primary function of Kupffer cells is to secrete bile. -These cells are the functional unit of the liver and are responsible for all liver secretions. -The cells are capable of removing and phagocytizing old and defective blood cells. -The role of the Kupffer cells is to provide at least 50% of cardiac output each minute to each lobular of the liver.

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

When educating the public about hepatitis A, the nurse will stress which accurate teaching points? Select all that apply. -Hepatitis is only transmitted via blood; therefore, just don't touch anything that looks like it contains blood. -The onset of symptoms include high fever, malaise, abdominal pain, and jaundice. -Persons working in various food industries like in a restaurant can pass on hepatitis A if they do not properly wash their hands after going to the toilet. -Be careful if traveling to a foreign country since many countries do not require vaccination of their workers. -The incubation period averages 25 to 26 weeks following exposure.

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

The community health nurse is teaching about prevention of hepatitis A. Which group does the nurse suggest will benefit from this vaccine? -Those who have been recently exposed to hepatitis A -Homosexual women -Those traveling to Third World countries -Those working for the Centers for Disease Control and Prevention

-Those traveling to Third World countries

A 16-year-old adolescent is hospitalized after ingesting 20 g of acetaminophen in a suicide attempt. The care team would recognize that this client faces risk for which potential complication? -Toxic hepatitis -Hepatitis D virus (HDV) infection -Secondary biliary cirrhosis -Portal hypertension

-Toxic hepatitis

Which signs and symptoms are most suggestive of acute cholecystitis? -Upper right quadrant or epigastric pain -Fever and sudden abdominal distention -Appearance of undigested fat in feces -Nausea resulting in greenish vomitus

-Upper right quadrant or epigastric pain

When assessing the client during the icteric phase of viral hepatitis, which of these findings does the nurse anticipate observing? -Yellow-tinged blood -Increased energy -Yellow-tinged sclera -Blood in the stool

-Yellow-tinged sclera

A client has been diagnosed with alcohol-induced liver disease. He admits to the nurse, "I know what the lungs do, and I know what the heart does, but honestly, I have no idea what the liver does in the body." The nurse should tell the client that the liver: -is responsible for the absorption of most dietary nutrients, as well as the production of growth hormones. -contributes to the metabolism of ingested food and provides the fluids that the GI tract requires. -metabolizes most components of food and also cleans the blood of bacteria and drugs. -maintains a balanced level of electrolytes and pH in the body and stores glucose, minerals, and vitamins.

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

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. -severe anorexia. -disappearance of jaundice. -chills and fever.

-severe pruritus and liver tenderness.

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description? -Pain in the right upper quadrant referred to the same shoulder -Pain in the back, radiating to the groin -Pain that starts as a diffuse ache and localizes over 24 to 48 hours -Pain in the left lower quadrant, radiating to the back

Pain in the right upper quadrant referred to the same shoulder

Both prehepatic and post-hepatic causes of portal hypertension include the formation of which abnormality? -Fibrous nodules -Venous thrombosis -Collateral circulation -Portosystemic shunts

Venous thrombosis

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 38.8°C (101.8°F), blood pressure 89/48 mm Hg 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 diagnosis would the care team suspect first? -Hepatitis C -Cholecystitis -Liver cirrhosis -Acute pancreatitis

Acute pancreatitis

Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication? -Cerebral hemorrhage -Acute tubular necrosis -Bilateral pneumothorax -Complete heart block

Acute tubular necrosis

A client has been diagnosed with cholestasis and is experiencing pruritus. The nurse caring for this client should be educating the client about reduced bile flow that will interfere with intestinal absorption of which vitamins? Select all that apply. -Vitamin A -Vitamin B -Vitamin C -Vitamin D -Vitamin K

Vitamin A Vitamin D Vitamin K

A client with persistent, recurring episodes of epigastric and upper left quadrant pain and anorexia, nausea, vomiting, constipation, and flatulence has been diagnosed with chronic pancreatitis. What is the cause of the symptoms of chronic pancreatitis? -Destruction of the common bile duct -Destruction of the endocrine pancreas -Destruction of both the endocrine and exocrine pancreas -Blockage of the common bile duct

Destruction of both the endocrine and exocrine pancreas

The nurse teaches that viral hepatitis damages the liver by which mechanism? -Direct cellular injury -Fatty liver changes -Disrupted bile flow -Bile duct inflammation

Direct cellular injury

Ascites is an accumulation of fluid in the peritoneal cavity and usually occurs in advanced cirrhosis. What is the treatment of choice for ascites? -Paracentesis -Thoracentesis -Diuretics -DDAVP

Diuretics

A decrease in the serum level of which substance is suggestive of liver injury? -Gamma-glutamyltransferase (GGT) -Albumin -Alanine aminotransferase (ALT) -Alkaline phosphatase

Albumin

A client with pancreatic cancer is admitted for portal hypertension and is symptomatic with ascites. Following paracentesis and removal of 7.5 L of ascitic fluid, the nurse should anticipate that the physician will order which medication to assist in maintaining an effective circulating fluid volume? -Bumetanide -Furosemide -Albumin (Human) 5%. -Epoetin alfa

Albumin (Human) 5%.

Which of these substances should the nurse teach the client with pancreatitis to absolutely avoid? -Narcotic analgesics -Fatty foods -Alcohol -Concentrated sweets

Alcohol

The nurse is teaching a group of nursing students about alcohol-induced liver disease and the cytochrome P450 system (CYP P450). Which of these is correct for the nurse to include in the lesson? -Impairment of the CYP P450 system may cause severe hypoglycemia. -This system prevents rapid metabolism of ethanol and subsequent intoxication. -Alcohol consumption enhances susceptibility to effects of drugs and toxins. -Alcohol is a source of calories, but cannot be stored as protein, fat, or carbohydrates.

Alcohol consumption enhances susceptibility to effects of drugs and toxins.

What could cause a client to develop a partial obstruction of the sphincter of the pancreas confirmed by X-ray? -Alcoholic beverages -Raw vegetables -Dairy products -Fatty foods

Alcoholic beverages

The nurse recognizes hepatic encephalopathy may be aggravated by which situation? -A high-protein meal -The lack of hemoglobin in the blood -Increased clotting factors in the blood -Excess albumin in the blood

A high-protein meal

What is considered the normal amount of serum bilirubin found in the blood? 1.7 mg/dL >1.8 mg/dL <1.5 mg/dL 2 mg/dL

<1.5 mg/dL

Which client on a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure? -A 44-year-old man with low hemoglobin levels, low platelet levels, and spider angiomas present -A 50-year-old woman with blood pressure of 189/103, jaundice, and multiple thromboses -A 68-year-old female client with sudden onset of confusion, a history of alcohol abuse, and low levels of serum AST and ALT -A 55-year-old man with ascites, fever, and recent onset of atrial fibrillation

A 44-year-old man with low hemoglobin levels, low platelet levels, and spider angiomas present

Which client is most likely to develop hepatocellular cancer? -A client who had an overdose of acetaminophen several years ago and who takes several prescription medications -A client who has been diagnosed with metastatic breast cancer -A client who has been smoking marijuana for many years -A client who received a liver transplant due to cirrhosis 6 years ago

A client who has been diagnosed with metastatic breast cancer

Four weeks after returning from a tropical vacation, a 40-year-old man has presented to the emergency department with malaise, nausea, and yellow sclera. Serology has confirmed a diagnosis of hepatitis A (HAV). What teaching is most appropriate for this client? -"You can expect these symptoms to disappear after about 2 months, but you will be a carrier of the disease indefinitely. -A vaccine before your trip would have prevented this, but your body will rid itself of the virus in time. -You likely came in contact with blood or body fluids at some point, and you will have to ensure no one is subsequently exposed to your own blood or body fluids. -You likely got this by way of what we call the fecal-oral contamination. You will have chronic hepatitis now, but the symptoms can be controlled with medication.

A vaccine before your trip would have prevented this, but your body will rid itself of the virus in time.

Which individual most likely faces the highest risk of developing chronic pancreatitis? -A woman who has six to eight alcoholic beverages each evening -A man who has become profoundly ill during a tropical vacation -A woman who takes 2 acetaminophen tablets five to six times a day -An obese man who has a high-fat diet and has a sedentary lifestyle

A woman who has six to eight alcoholic beverages each evening

Which factor is most strongly associated with the pathogenesis of gallstone formation? -Excess serum ammonia and urea levels -Portal hypertension -Abnormalities or stasis of bile -High-cholesterol diet

Abnormalities or stasis of bile

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 -Prothrombin time -Transaminase level -Aldosterone levels

Ammonia level

The nurse teaches the client with acute pancreatitis that the pain is caused by prematurely activated pancreatic enzymes that have leaked into surrounding tissues, causing which outcome? -Fatty deposits -Autodigestion -Bowel obstruction -Abscess formation

Autodigestion

The client has right upper quadrant pain caused by acute choledocholithiasis. The health care provider suspects the common bile duct is obstructed, based on which flowing lab value? -Albumin 2.0 g/dL (20 g/L) (low) -Amylase 150 units/L (2.50 µkat/L) (high) -Bilirubin 15 mg/dL (256.56 µmol/L) (high) -Serum calcium level 7 mg/dL (1.75 mmol/L) (low)

Bilirubin 15 mg/dL (256.56 µmol/L) (high)

A client presents with epigastric pain, a mild fever, nausea, and vomiting. His history shows a previous episode with similar symptoms that reverted in 24 hours. This time the pain is not subsiding. What diagnosis is the most likely? -Calculous cholecystitis -Cirrhosis -Hepatitis C virus (HCV) -Pancreatic cancer

Calculous cholecystitis

When caring for the client with pancreatic cancer, for which of these signs and symptoms does the nurse assess? -Fever, chills, and weight loss -Central abdominal pain, jaundice, and weight loss -Abdominal and back pain that lessen when lying flat -A large abdominal mass, left upper quadrant pain, and vomiting

Central abdominal pain, jaundice, and weight loss

Many drugs are metabolized and detoxified in the liver. Most drug metabolizing occurs in the central zones of the liver. What condition is caused by these drug-metabolizing actions? -Central cirrhosis -Lobular cirrhosis -Lobular necrosis -Centrilobular necrosis

Centrilobular necrosis

When assessing the nutritional intake of a client with generalized pancreatic cancer, which statement by the client is consistent with the disease and food intake? -Client reports pain is worse 2 hours after eating. -Client states pain becomes worse with food intake. -Client states eating causes vomiting. -Client states consuming liquids with meals makes the pain worse.

Client states pain becomes worse with food intake.

A client with a history of chronic pancreatitis asks about potential long-term complications. Which response by the nurse would be most accurate? -Clients can develop signs of diabetes and malabsorption. -Chronic pancreatitis can lead to liver failure and cirrhosis. -Long-term effects are similar to those seen in cholelithiasis. -Clients with chronic pancreatitis develop portal hypertension.

Clients can develop signs of diabetes and malabsorption.

A client is admitted to a nursing unit with severe edema. The nursing student caring for this client overhears the physician and a medical student talking about the client's albumin level. When discussing the flow of fluids into and out of cells, albumin plays a significant role in which pressure gradient? -Hydrostatic -Diffusion -Transcellular -Colloidal osmotic

Colloidal osmotic

A 53-year-old woman with a history of chronic alcohol abuse but without visible jaundice comes to the clinic complaining of nausea and weakness. She admits to taking acetaminophen for persistent headaches but denies exceeding the recommended daily dose; she has not taken any other medications. She is suspected of having acetaminophen toxicity. Which diagnostic test finding would implicate a different cause of her symptoms? -Normal serum acetaminophen level -Elevated serum HBsAG level -Evidence of steatosis on liver biopsy tissue sample -Hypoglycemia

Elevated serum HBsAG level

A client with a history of chronic alcohol use but without visible jaundice comes to the clinic reporting nausea and weakness. She admits to taking acetaminophen for persistent headaches but denies exceeding the recommended daily dose; she has not taken any other medications. She is suspected of having acetaminophen toxicity. Which diagnostic test finding would suggest a different cause of her symptoms? -Normal serum acetaminophen level -Elevated serum HBsAG level -Evidence of steatosis on liver biopsy tissue sample -Hypoglycemia

Elevated serum HBsAG level

A health care provider has completed an assessment on a client diagnosed with cirrhosis. The client asks, "What, if any, serious complications are associated with cirrhosis?" Which response is the most accurate for the provider to relay to the client? -Esophageal varices -Duodenal ulcers -Biliary colic -Dehydration

Esophageal varices

The nurse recognizes which of these complications results from liver failure with decrease in production of bile salts? -Fat-soluble vitamin deficiencies -Jaundice -Cushing syndrome -Hypoglycemia

Fat-soluble vitamin deficiencies

The nurse is caring for a client with liver disease who has elevated serum alpha fetoprotein levels. The nurse recognizes this lab result is consistent with which condition in an adult? -Toxic hepatitis -Rejection of transplanted liver -Hepatocellular cancer -Pregnancy

Hepatocellular cancer

A client has just been diagnosed with cirrhosis and has been told he needs a transplant. What changes have occurred in the liver due to cirrhosis that results in an inability to heal and require transplant? -The client's hepatocytes have necrotized. -Fibrosis has occurred and there are constrictive bands that disrupt biliary flow. -Liver ischemia has occurred, resulting in anoxic damage to the liver. -Apoptosis is induced, resulting in total loss of hepatic tissue.

Fibrosis has occurred and there are constrictive bands that disrupt biliary flow.

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 and accompanying altered diagnostic results does the nurse anticipate? -Hepatocellular necrosis evidenced by increased ALT and AST levels. -Allergic inflammation accompanied by an increase in serum IgE and basophils. -Cholestatic reaction with increased bilirubin count -Rapid onset of hepatitis and increased GGT, ALT, and bilirubin

Hepatocellular necrosis evidenced by increased ALT and AST levels.

Which physiologic abnormality is thought to be a precursor of gallstones? -Gallbladder sludge -Thinned mucoprotein -Pieces of hard food trapped in the gallbladder -Thickened bile

Gallbladder sludge

The nurse is caring for a client with hepatitis A who is tired of feeling ill. Which of these does the nurse convey to the client? -Symptoms of hepatitis A last for 3 to 6 months. -Hepatitis A symptoms last for 8 weeks. -Without rest the client may progress to a chronic phase. -The client should consider accepting the hepatitis A vaccine.

Hepatitis A symptoms last for 8 weeks.

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? -The liver is very vascular and is always filled with blood to maximum capacity. -In right-sided heart failure, there is high pressure in the inferior vena cava that backlogs blood into the liver. -Since the heart cannot pump effectively, blood is moving very slowing in both the arterial and venous vessels; therefore, blood cannot move out of the liver very fast. -The lobules, which are the functional unit of the liver, cannot move blood very rapidly out of the veins so it just pools there until BP is increased.

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

The nurse is caring for a client with alcoholism who now presents with gastrointestinal bleeding. What alteration does the nurse anticipate related to the bleeding? -Increase in ammonia level -Decreased glucose synthesis -Decreased prothrombin time -Increased triglycerides

Increase in ammonia level

A nurse reviewing the lab results of a client diagnosed with cholestasis would expect to find which abnormality? -Increased serum alkaline phosphate -Increased serum glucose level -Decreased serum bilirubin -Decreased plasma bile salts

Increased serum alkaline phosphate

The client reports something "wrong" with his gallbladder. Which manifestation does the nurse recognize that supports the client's concern? -Abrupt onset of right lower quadrant pain and chills -Intolerance to greasy food; burping -Fluid retention and edema of the hands and feet -Craving for carbohydrates

Intolerance to greasy food; burping

A client is prescribed erythromycin for an infection. What manifestations will the nurse recognize that indicate the onset of drug-induced cholestasis? -Nausea and diarrhea -Jaundice and pruritus -Fatigue and depression -Ascites and immunosuppression

Jaundice and pruritus

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 -Ultrasonography -Computed tomography (CT) -Angiography of hepatic artery

Laparoscopic liver biopsy

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

Limit intake of sodium.

A client presents to the emergency department with some vague symptoms. After history and physical exam, the physician is suspecting the client may have viral hepatitis. Which clinical manifestation leads the nurse to suspect the client is in the prodromal period of viral hepatitis? -Slight jaundice in the sclera of the eyes -Liver tenderness on palpation -Onset of severe itching with skin breakdown -Muscle aches and pain along with fatigue

Muscle aches and pain along with fatigue

When caring for a client with intermediate stage alcoholic hepatitis, the nurse recognizes which physiologic process is taking place? -Necrosis -Nodules -Atrophy -Hypertrophy

Necrosis

One of the jobs the liver performs is to export triglyceride. When the liver's capacity to export triglyceride is exceeded, excess fatty acids accumulate in the liver. To what disease do these excess fatty acids contribute? -Biliary cirrhosis -Nonalcoholic fatty liver disease -Cholelithiasis -Alcoholic fatty liver disease

Nonalcoholic fatty liver disease

A client with a history of alcohol abuse presents to the emergency department vomiting large amounts of bright red blood that the health care provider suspects is due to esophageal varices. Which drug that reduces splanchnic and hepatic blood flow should the nurse anticipate being prescribed? -Propranolol, a beta-adrenergic blocking agent -Lisinopril, an ACE inhibitor -Octreotide, a long-acting synthetic analog of somatostatin -Famotidine, a histamine-2 blocker to decrease stomach acid

Octreotide, a long-acting synthetic analog of somatostatin

To reduce hepatic blood flow and decrease portal pressures in persons with cirrhosis, the nurse should be prepared to administer which medication? -Bevacizumab, an angiogenesis inhibitor. -Octreotide, a long-acting synthetic analog of somatostatin. -Filgrastim, granulocyte colony-stimulating factor (G-CSF) analog. -Diltiazem, a calcium channel blocker.

Octreotide, a long-acting synthetic analog of somatostatin.

The nurse is caring for a client with metastatic pancreatic cancer who is to undergo a surgical resection and radiation therapy. What does the nurse recognize is the goal of these interventions? -Cure of the cancer -Palliation of symptoms -Removal of the tumor -Diagnosis of the tumor

Palliation of symptoms

When teaching the client about the cause of acute pancreatitis, which of these points should be included in the teaching session? -The pancreas has developed inflammation due to ingestion of acetaminophen. -Pancreatic enzymes are activated before leaving the pancreas, causing injury. -An infection of the pancreas has occurred. -The only way to get pancreatitis is from alcohol abuse.

Pancreatic enzymes are activated before leaving the pancreas, causing injury.

When teaching a group of nursing students about the liver, the nurse relates that Kupffer cells function to remove harmful substances or cells from the portal blood and venous sinusoids through which process? -Ultrafiltration -Osmosis -Phagocytosis -Cytotoxic action

Phagocytosis

A client's long-standing diagnosis of congenital hemolytic anemia often manifests itself with jaundice. What type of jaundice does this client most likely experience? -Prehepatic -Intrahepatic -Post-hepatic -Infectious

Prehepatic

A client in liver failure asks, "How does the liver process ammonia in healthy individuals?" Which explanation from the health care provider explains the mechanism how ammonia is removed from the blood by the liver? -Converts ammonia into bilirubin, which is then excreted intestinally -Processes ammonia into nitrogen and hydrogen ions for excretion -Processes ammonia into urea, releasing it into the circulation -Combines ammonia with oxygen to create ammonium oxide

Processes ammonia into urea, releasing it into the circulation

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 -Icterus phase -Convalescent phase -Chronic period

Prodromal period

When teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition? -Alcohol abuse -Progressive destruction of the organ -Easily cured with antibiotic therapy -Weight gain

Progressive destruction of the organ

The nurse is caring for the client with extrahepatic cholestasis. Which symptom does the nurse anticipate uncovering during the history and assessment? -Complaints of lower flank pain with consequences of impaired fat metabolism. -Anorexia with consequences of impaired drug metabolism and blood filtration. -Skin xanthomas (focal accumulations of cholesterol) with consequences of increased risk of bleeding due to deficient clotting factors. -Pruritus with consequences of deficient levels of fat-soluble vitamins.

Pruritus with consequences of deficient levels of fat-soluble vitamins.

The nurse assessing a client with a diagnosis of cholelithiasis will look for pain in which area?

Right upper quadrant

What intervention does the nurse suggest to a client experiencing pain associated with pancreatic cancer? -Sleeping in a forward sitting position -Avoiding extremes in temperature change -Assuming the supine position whenever possible -Applying moist, warm compresses to the back

Sleeping in a forward sitting position

The nurse is caring for a client with hypovolemic shock. Which of these does the nurse recognize is the liver's contribution to compensate for shock states? -Stored blood in the liver can shift to general circulation to restore blood volume. -The liver synthesizes ADH to retain water during periods of deficiency. -The liver makes substances which constrict blood vessels to raise blood pressure. -Kuppfer cells are responsible for regulating blood volume and blood vessel tone.

Stored blood in the liver can shift to general circulation to restore blood volume.

A client is diagnosed with choledocholithiasis and acute suppurative cholangitis and is being rushed to surgery to prevent which possible complication? -The accumulation of purulent bile, which can cause sepsis. -Hepatitis that can result from the distention of the bile duct. -Impaired nutritional absorption -Neurologic damage that can be caused by toxic bilirubinemia.

The accumulation of purulent bile, which can cause sepsis.

A client is suspected to have developed primary biliary cirrhosis. While taking the client's history, the nurse will note that the earliest symptoms of this disorder include: -abdominal pain due to an enlarged liver and spleen. -pale stools, elevated bilirubin levels, and confusion due to elevated ammonia levels. -itching, fatigue, and dark urine. -vomiting blood and passing bloody stools.

itching, fatigue, and dark urine.

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 is responsible for the absorption of most dietary nutrients as well as the production of growth hormones. -The liver contributes to the metabolism of ingested food and provides the fluids that the GI tract requires. -The liver metabolizes most components of food and also cleans the blood of bacteria and drugs. -The liver maintains a balanced level of electrolytes and pH in the body and stores glucose, minerals and vitamins.

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

Hepatocellular cancer usually has a poor prognosis due in part to which factor? -The nonspecific symptomatology of liver cancer leads to a diagnosis at a late stage. -Liver cancer typically metastasizes at a much earlier stage than other cancers. -Liver tumors are poorly differentiated due to the low density of hepatic tissue. -Surgical options do not exist because removal of all or part of the liver is a threat to health.

The nonspecific symptomatology of liver cancer leads to a diagnosis at a late stage.

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 autoimmune destruction of the bile ducts. -A viral infection has begun to destroy the liver. -The pregnant mother passes this process along to the fetus in utero. -Sustained, heavy alcohol use causes this problem.

There is autoimmune destruction of the bile ducts.

Primary biliary cirrhosis is an autoimmune disease that destroys the small intrahepatic bile ducts causing cholestasis. It is insidious in onset and is a progressive disease. What are the earliest symptoms of the disease? -Unexplained pruritus -Weight gain -Pale urine -Dark stools

Unexplained pruritus

The nurse recognizes which intervention is essential to reduce the pain of acute pancreatitis? -Administering medication for pain -Withholding food and fluid -Providing intravenous fluids and electrolytes -Administration of antiemetics

Withholding food and fluid

A newborn is admitted to the hospital with a high bilirubin level of 13 mg/dL (222.35 µmol/L). The assessment data related to this lab value includes: Select all that apply. -Yellowish discoloration of the skin -Colicky, intermittent pain associated with formula feeding -Xanthomas -Yellowing of the sclera of the eye -Dark-colored urine

Yellowish discoloration of the skin Yellowing of the sclera of the eye Dark-colored urine

Cholestasis is a condition in which there is a decrease in bile flow through the intrahepatic canaliculi and a reduction in secretion of water, bilirubin, and bile acids by the hepatocytes. Cholestasis can have more than one cause, but in all types of cholestasis, there is: -accumulation of bile pigment in the gallbladder. -accumulation of bile pigment in the liver. -accumulation of bile pigment in the blood. -accumulation of bile pigment in the portal vein.

accumulation of bile pigment in the liver.

When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby: -activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. -the pancreas is irreversibly damaged and will not recover to normal functioning (chronic). -the pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction. -stones will develop in the common bile duct, resulting in acute jaundice.

activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue.

The nurse is implementing a plan of care for a client who has developed acute pancreatitis. It is most important for the nurse to: -initiate gastric suctioning to prevent the synthesis of pancreatic enzymes. -encourage intake of a high-protein, high-carbohydrate diet. -withhold pain medications until the location of the pain is identified. -increase the amount of fluids by offering oral fluids every hour.

initiate gastric suctioning to prevent the synthesis of pancreatic enzymes.