Chapter 30: Disorders of Hepatobiliary and Exocrine Pancreas Function

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

Hepatocellular necrosis evidenced by increased ALT and AST levels.

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

High serum amylase and lipase

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

Hyperglycemia

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

Hyperglycemia due to inability to synthesize insulin

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

Illness with hepatitis B or C

The health care provider has completed the assessment of a client who presented to the emergency department with jaundice. The provider determines that the jaundice is a result of:

Impaired uptake of bilirubin by the liver

When caring for the client with Laennec's cirrhosis, the nurse recognizes which of these is an expected etiology of jaundice?

Impaired uptake of billirubin

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

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

A nurse is reviewing laboratory results of a client that were ordered to assess liver function .The results indicating injury to liver cells would include:

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?

Liver transplant

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

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

The nurse is assessing a client with a history of long-term alcohol use for signs and symptoms of early cirrhosis. Which of these questions by the nurse will help elicit these early symptoms?

"Do you find your appetite is poor lately?"

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

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

Following several days of intermittent upper right quadrant pain, a 29 year-old obese, Native American 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 of the following statements by the client demonstrates a sound understanding of her diagnosis?

"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 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?

"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 byproducts."

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

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

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

Pain in the right upper quadrant referred to the same shoulder

Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which of the following complications?

Acute tubular necrosis

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

Diuretics

A patient with pancreatic cancer is admitted for portal hypertension in which they are symptomatic with ascites. Following paracentesis and removal of 7.5 L of ascitic fluid the nurse should anticipate that the physician will order which of the following medications to assist in maintaining an effective circulating fluid volume?

Albumin (Human) 5%.

Which of these substances should the nurse teach the client with pancreatitis is essential to avoid?

Alcohol

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?

Alcoholic hepatitis

What is considered the normal amount of serum bilirubin found in the blood?

<1.5mg/dL

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

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

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 what?

Accumulation of bile pigment in the liver

When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize the pathogenesis begins with an inflammatory process whereby:

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

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

Acute pancreatitis

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

Ammonia level

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

Amylase and lipase

The client has right upper quadrant pain caused by acute choledocholithiasis. The health care provider suspects the common bile duct is obstructed, based on which of the flowing lab values?

Bilirubin 15 mg/dL (high)

When caring for the client with pancreatic cancer, for which of these signs and symptoms does the nurse assess?

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?

Centrilobular necrosis

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

Cigarette smoking

When assessing the nutritional intake of a client with generalized pancreatic cancer, which of these statements by the client is consistent with the disease and food intake?

Client states pain becomes worse with food intake.

A client with a history of chronic pancreatitis is concerned about developing long-term complications. The best response by the nurse would be

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?

Colloidal osmotic

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 of the following treatments is most likely to be effective for her?

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 which of these altered diagnostic tests is consistent with development of edema?

Decreased albumin

The physician has just completed an assessment on a client diagnosed with cirrhosis. The client asks if she is at risk for any serious complications. Which would be the best response?

Esophageal varices

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

Fats

The nurse is caring for a client with liver disease who has elevated serum alpha fetoprotein levels. The nurse recognizes this result is consistent with which of these conditions in adults?

Hepatocellular cancer

Gallstones are made up mostly of cholesterol. What is thought to be a precursor of gallstones?

Gallbladder sludge

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

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

Increased prothrombin time

When caring for the client with hepatic failure, the nurse recognizes which of these problems places the client at increased risk for bleeding?

Increased prothrombin time

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

Intolerance to greasy food; burping

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

Jaundice and pruritus

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

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 of these symptoms does the nurse recognize are consistent with this phase? Select all that apply.

Lack of energy Myalgia Lack of appetite

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

Laparoscopic liver biopsy

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

Limit intake of sodium.

What laboratory markers are most commonly used to diagnose acute pancreatitis?

Lipase and amylase

The nurse is caring for a client with metastatic pancreatic cancer who is to undergo a surgical resection and radiation therapy. Which of these does the nurse recognize is the goal of these interventions?

Palliation of symptoms

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

Progressive destruction of the organ

Following a needlestick injury, a nurse develops hepatitis C. Even though they received the proper treatment within a timely manner, it develops into a chronic infection. The healthcare provider counsels the nurse to assess for which of the following major complications that can result from this chronic condition? Select all that apply.

Progressive liver fibrosis. • Liver cancer.

A client is suspected of having the onset of alcoholic liver disease. The nurse should be assessing for which of the following manifestations related to the necrosis of liver cells?

Rapid onset of jaundice

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

Right upper quadrant pain

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

Severe pruritus and liver tenderness

What intervention does the nurse suggest to a patient experiencing pain associated with pancreatic cancer?

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 the circulation to restore blood volume.

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

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

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

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

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

Those traveling to third world countries

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

Yellow-tinged sclera

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

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

A client is 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:

itching, fatigue, and dark urine.

When planning care for the client with hemorrhage related to esophageal varices, the nurse anticipates which of these measures will be used to control bleeding? Select all that apply.

• Administration of octreotide • Balloon tamponade • Use of propranolol

The oncology nurse is teaching a group of nursing students about risk factors for pancreatic cancer. Which of these does the nurse include in the teaching session? Select all that apply.

• Age over 50 years • Chronic pancreatitis • Cigarette smoking

A patient has just been admitted to a nursing unit with the diagnosis of obstructive jaundice. Which of the following assessment findings would the nurse expect to see in this patient? Select all that apply.

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

Clients with chronic autoimmune hepatitis may display which of the following clinical manifestations upon physical exam? Select all that apply.

• Enlarged liver • Jaundice

A client had developed jaundice. The nurse recognizes that the jaundice may have resulted from: Select all that apply.

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

The nurse recognizes that which of these individuals are at risk for hepatitis B? Select all that apply.

• Injection drug users • Those having unprotected sex

A client with chronic hepatitis B is undergoing diagnostic testing for possible liver cancer. Upon taking a history and performing a physical exam, the nurse can correlate the possible cancer diagnosis with which clinical manifestations? Select all that apply.

• Reports "abdominal fullness and bloating." • States "My abdomen is getting larger since and I can no longer get my belt buckled."

A client is undergoing diagnostic testing for possible liver failure. While educating a group of nursing students, the nurse asks them what the clinical manifestations of liver failure include. Which answers are accurate? Select all that apply.

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

A client is concerned about acquiring hepatitis A and asks the nurse who should receive the HAV vaccine. The best response would be: Select all that apply.

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

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 of the following vitamins? Select all that apply.

• Vitamin A • Vitamin D • Vitamin K