Custom: Liver, Pancreas, and Gallbladder ATI

A nurse is planning care for a client who has cirrhosis of the liver. Which of the following actions should the nurse include in the plan? (Select all that apply.)

a: Administer furosemide c: Implement a low-sodium diet d: Measure the client's abdominal girth

A nurse is caring for a client who is postoperative following a cholecystectomy and reports pain. Which of the following actions should the nurse take? (Select all that apply.)

a: Offer the client a back rub b: Remind the client to use incisional splinting c: Identify the client's pain level e: Change the client's position

A nurse is talking with a client who has cholelithiasis and is about to undergo an oral cholangiogram. Which of the following client statements indicates to the nurse understanding of the procedure?

A: "They are going to examine my gallbladder and ducts." With oral cholangiography, the client receives an iodide-containing contrast agent 10 to 12 hr before the procedure. Then, the examiner can evaluate the gallbladder for filling, contracting, and emptying and can also see the gallstones on the x-rays.

A nurse is teaching a community education course about the physical complications related to substance use disorder. Which of the following findings should the nurse identify as the primary cause of liver cirrhosis?

A: Alcohol Chronic alcohol use disorder is one of the primary causes of cirrhosis of the liver.

A nurse is planning care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include in the plan of care?

A: Decrease the client's fluid intake. The nurse should restrict fluids for a client who has cirrhosis and ascites due to the client's risk for increased fluid retention.

A nurse is caring for a client who has liver cirrhosis with ascites, bleeding esophageal varices, and portal hypertension. The nurse recognizes which of the following laboratory findings as indicating the client's GI tract is digesting and absorbing blood?

A: Elevated blood urea nitrogen (BUN) As the body digests blood, BUN rises. An elevated BUN is an indication of GI bleeding.

A nurse is assessing a client who has an obstruction of the common bile duct resulting from chronic cholecystitis. Which of the following findings should the nurse expect?

A: Fatty stools Chronic cholecystitis occurs following several bouts of acute cholecystitis. The repeated episodes of inflammation result in a fibrotic and contracted gallbladder. Because of inflammation in the gallbladder, bile needed to absorb fat and fat-soluble vitamins is unable to enter the bowel, resulting in steatorrhea (fatty stools).

A nurse is interviewing a client who has acute pancreatitis. Which of the following factors should the nurse anticipate finding in the client's history?

A: Gallstones The client's history might reveal biliary obstruction from a gallstone causing bile to inflame the pancreas.

A nurse is assessing a client who has advanced cirrhosis. Which of the following manifestations should the nurse expect?

A: Petechiae A manifestation of advanced cirrhosis is petechiae due to impaired coagulation from a dysfunctional liver.

A nurse is planning care for a client who has viral hepatitis. Which of the following actions should the nurse include in the plan of care?

A: Provide a high carbohydrate diet. A client with hepatitis should have a diet high in carbohydrates due to altered nutrient metabolism.

A nurse is providing discharge teaching for a client who has acute pancreatitis, and has a prescription for fat-soluble vitamin supplements. The nurse should instruct the client to take a supplement for which of the following?

A: Vitamin A The nurse should instruct the client that fat-soluble vitamins include vitamins A, D, E, and K.

A nurse is caring for a client who has cirrhosis and a prothrombin time of 30 seconds. Which of the following medications should the nurse plan to administer?

A: Vitamin K A prothrombin time of 30 seconds indicates the clotting time is prolonged and bleeding could occur. Vitamin K injection increases the synthesis of prothrombin by the liver; therefore, the nurse should plan to administer vitamin k.

A nurse is providing discharge teaching for a client who has chronic pancreatitis. Which of the following statements should the nurse make?

B: "You should increase your daily intake of protein." Clients who have chronic pancreatitis should consume a diet that is high in protein.

A nurse is assessing clients in a health clinic for risk factors for contracting hepatitis. Which of the following clients is at risk for developing hepatitis C?

B: A client who has multiple tattoos Hepatitis C is transmitted via blood-to-blood contact. The nurse should recognize that improperly maintained tattoo equipment may aid in transmission and could increase the client's risk for contracting hepatitis C.

A nurse is preparing to administer a dose of lactulose to a client who has cirrhosis. The client states, "I don't need this medication. I am not constipated." The nurse should explain that in clients who have cirrhosis, lactulose is used to decrease levels of which of the following components in the bloodstream?

B: Ammonia Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents absorption of ammonia in the colon. Accumulation of ammonia in the bloodstream, which occurs in pathologic conditions of the liver, such as cirrhosis, may affect the central nervous system, causing hepatic encephalopathy or coma.

A nurse is providing care for a client who had a laparoscopic cholecystectomy. Which of the following is an appropriate nursing action?

B: Encourage ambulation once fully awake. The nurse should encourage ambulation once the client is fully awake to promote absorption of the carbon dioxide used during the laparoscopy. This minimizes the client's discomfort. The nurse should check the client for nausea before ambulating, and administer an anti-emetic medication if necessary.

A nurse is assessing a client who is African-American and has jaundice. Which of the following areas is the most reliable for the nurse to inspect the client for jaundice?

B: Hard Plate According to evidence-based practice, inspecting the client's oral mucous membrane and hard palate are the most reliable methods to determine jaundice for a client who is African-American.

A nurse admits a client to the emergency department who reports N/V that worsens when he lies down. Antacids do not help. The provider suspects acute pancreatitis. Which of the following laboratory test results should the nurse expect to see?

B: Increased serum-amylase With acute pancreatitis, serum amylase rises within 24 hr of the start of the client's symptoms.

A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the nurse anticipate?

B: Pantoprazole 80 mg IV bolus twice daily The nurse should anticipate a provider's prescription for a proton pump inhibitor to decrease gastric acid production, which ultimately decrease pancreatic secretions.

A nurse is teaching a client who has cholecystitis about required dietary modifications. The nurse should include which of the following foods as appropriate for the client's diet?

B: Roast turkey Roast turkey is a low-fat protein that is an appropriate choice for inclusion in the client's diet. Low-fat food decreases stimulation of the gallbladder, thereby reducing associated symptoms.

A nurse is caring for a client who has just returned from the PACU after a traditional cholecystectomy. In which of the following positions should the nurse place the client?

B: Semi-Fowler's The nurse should expect a prescription to place the client in semi-Fowler's position following a traditional cholecystectomy to facilitate lung expansion as well as coughing and deep breathing. This position will place minimal stress on the abdomen and increase comfort.

A nurse is assessing a client who has cirrhosis. Which of the following is an expected finding for this client?

B: Spider angiomas Spider angiomas are lesions with a red center and numerous extensions that spread out like a spider web. This is an expected finding for a client who has cirrhosis.

A nurse is teaching a group of middle adult clients about early detection of colorectal cancer. The nurse should include the American Cancer Society recommendations that men and women beginning at age 50 who are at average risk should have a fecal occult blood test (FOBT) and a colonoscopy at which of the following intervals?

B: Ten years Ten years is the recommended interval for colonoscopy screening for clients who have an average risk.

A nurse is caring for a client who has cirrhosis and a new prescription for lactulose. Which of the following manifestations indicates an adverse effect of the medication?

B: Vomiting The nurse will monitor for vomiting as an adverse effect of lactulose.

A nurse is caring for a client who has been diagnosed with end-stage liver cancer. Which of the following responses is an indication the client is in the denial phase of the grief process?

C: "The doctor says I only have a few months to live, but I know he is exaggerating to get me to take my medication." This client statement is an example of denial. The five stages of grief might not be experienced in order, and the length of each stage will vary from person to person. In the denial stage, clients have difficulty believing a terminal diagnosis or loss. In the anger stage, clients lash out at other people or things. In the bargaining stage, clients negotiate for more time or a cure. In the depression stage, clients are saddened over the inability to change the situation. In the acceptance stage, clients accept what is happening and plan for the future.

A nurse is caring for a client who has cancer and is receiving total parenteral nutrition (TPN). Which of the following lab values indicates the treatment is effective?

C: Albumin 4.2 g/dL Clients who have cancer can receive TPN to provide needed proteins and glucose they are otherwise unable to obtain. An albumin level of 4.2 g/dL is within the expected reference range and indicates the client is receiving adequate amounts of protein.

A nurse is teaching a class about preventive care to clients who are at risk for acquiring viral hepatitis. Which of the following information should the nurse include in the presentation?

C: Avoid food prepared with tap water. To decrease the risk for acquiring viral hepatitis, clients should prepare foods with purified water.

A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan?

C: Avoid foods high in fat The nurse should instruct the client to follow a low-fat diet to decrease episodes of biliary colic. A client who has chronic cholecystitis has intolerance to fatty foods.

A nurse is caring for a client who is postoperative following an open cholecystectomy. Which of the following actions should the nurse take when caring for the client's Jackson-Pratt (JP) drain?

C: Expel the air from the JP bulb after emptying to re-establish suction. With the drainage and the air removed and the bulb tightly closed, the system works to exert gentle negative pressure, facilitating the removal of accumulated fluid from the surgical area.

A nurse is caring for a client who has cirrhosis and has a prescription for bumetanide. When delivering the client's lunch tray. Which of the following items should the nurse identify as contraindicated for the client?

C: Ham sandwich Ham is high in sodium and can increase fluid retention, leading to edema. Clients who have cirrhosis are prone to edema as the osmotic pressures change due to a decrease in plasma albumin and are placed on low-sodium diets.

A nurse is caring for a newborn whose mother is positive for the hepatitis B surface antigen. Which of the following should the infant receive?

C: Hepatitis B immune globulin and hepatitis B vaccine within 12 hr of birth. A newborn whose mother is positive for the hepatitis B surface antigen should receive both the hepatitis B vaccine and the hepatitis B immune globulin within 12 hr of birth.

A nurse is teaching a client who has hepatitis A. Which of the following information should the nurse include?

C: Manifestations of the virus are similar to flue-like symptoms. The nurse should include in the teaching that the manifestations of hepatitis A are similar to having the flu or a gastrointestinal illness. Often the client is unaware that they have acquired the virus.

A nurse is teaching a client who has hepatitis A about preventing transmission of the virus. Which of the following strategies should the nurse include in the teaching?

C: Practice effective hand hygiene. Effective hand hygiene—along with immunization, sewer sanitation, and a safe water supply—are the most effective strategies for preventing the transmission of hepatitis A.

A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the following interventions should the nurse plan to implement to decrease the client's ammonia level?

C: Reduce the client's intake of protein. Ammonia is formed in the gastrointestinal tract by the action of bacteria on protein. Limiting dietary protein intake can assist with decreasing the client's ammonia level. Protein is necessary for healing, so strict limitation of dietary protein is not recommended.

A nurse is teaching self-management to a client who has hepatitis B. Which of the following instructions should the nurse include in the teaching?

C: Rest frequently throughout the day. Limiting activity is usually recommended until the symptoms of hepatitis have subsided. The nurse should recommend the client rest frequently throughout the day to reduce the metabolic demands upon the liver and decrease energy demands.

A nurse is planning care for a client who is postoperative following a liver transplant and weighs 65kg. Which of the following actions should the nurse plan to take?

C: Stress the importance of safe food-handling practices. The nurse should stress the importance of safe food-handling practices to avoid foodborne illness due to the immunosuppressant medications the client is taking.

A nurse is leading a group therapy session for clients who are newly diagnosed with cancer. Which of the following statements should the nurse make?

D: "Let's discuss what you mean when you say that you cannot ever return to work." This is an example of clarification, which is a therapeutic communication technique. Clarification asks the group member to expand and clarify what he/she means so as to create a better understanding during the group session.

A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of the following values?

D: Amylase Amylase is an enzyme that changes complex sugars into simple sugars that can be used by the body. It is produced by the pancreas and salivary glands and released into the mouth, stomach, and intestines to aid in digestion. The amylase level of a client who has acute pancreatitis usually increases within 12 to 24 hr and can remain elevated for 2 to 3 days.

A nurse is providing teaching to a client who has a history of pancreatitis. Which of the following food choices should the nurse instruct the client to avoid?

D: Cheddar Cheese Clients who have pancreatitis should avoid foods high in fat. Cheddar cheese is high in fat content and the client should avoid this food choice.

A nurse is caring for a client who has suspected cholecystitis. The nurse should expect the client's urine to appear which of the following colors?

D: Dark and foamy The nurse should expect the client to have dark and foamy urine, which indicates the kidneys are filtering excess bilirubin from the blood.

A nurse is administering an IM injection to a client who has hepatitis C. Before placing the syringe and needle in a puncture-resistant container, which of the following actions should the nurse take?

D: Dispose of the needle uncapped. The nurse should immediately place the uncapped needle in a puncture-resistant container to prevent a needle stick with the contaminated needle.

A nurse is planning care for a client who has hepatitis B. Which of the following interventions should the nurse include in the plan?

D: Encourage short periods of ambulation The nurse should encourage a client who has hepatitis B to alternate between activity and rest.

A nurse is caring for a client who has just been diagnosed with cancer of the colon. The client asks the nurse several questions about what the provider might be planning to do. Which of the following nursing responses should the nurse make?

D: Encourage the client to write down questions to ask the provider. The nurse does not know the answers to the client's questions, so helping the client to prepare questions for the provider addresses the client's needs.

A nurse is teaching a client who is receiving treatment for metastatic colorectal cancer about the adverse effects of bevacizumab with. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication?

D: Nosebleeds Nosebleeds are an adverse effect of bevacizumab and should be reported to the provider. The client has an increased risk when taking this medication for severe bleeding from nosebleeds, vaginal bleeding, GI bleeding, intracranial bleeding and pulmonary bleeding, which may be caused from the development of thrombocytopenia and other blood disorders.

A nurse is teaching a client about causes of biliary cirrhosis. Which of the following information should the nurse include in the teaching?

D: Obstruction of the bile duct Prolonged obstruction of the common bile duct is the most common cause of biliary cirrhosis.

A nurse is admitting a client to the surgical unit from the PACU following a cholecystectomy. Which of the following assessments is the nurse's priority?

D: Oxygen saturation The priority action the nurse should take when using the airway, breathing, circulation approach to client care is to assess the client's oxygen saturation. The nurse should check the client's airway, listen to the client's breath sounds, and check the client's pulse oximetry to assess for respiratory depression.

A nurse is preparing to administer the hepatitis B vaccine to a client. Which of the following techniques should the nurse use to locate the deltoid muscle?

D: Place 1 finger across the acromion process and measure 3 fingerbreadths below to the midpoint and center of the lateral aspect of the upper arm. This identifies the deltoid muscle, into which the nurse should inject the vaccine.

A nurse is admitting a client who has hepatitis C. Which of the following precautions should the nurse implement?

D: Standard Hepatitis C is a blood-borne pathogen that is commonly spread by needle stick injury, sharing of IV drug paraphernalia and sexual contact. The nurse should implement standard precautions when in contact with blood, body fluids (except sweat), broken skin, and mucous membranes. The nurse should wear additional personal protective equipment if there is possible blood contact or a risk for splashes or sprays of blood or body fluids.

A nurse is caring for a client who has acute pancreatitis. After treating the client's pain, which of the following should the nurse address as the priority intervention?

D: Withhold oral fluids and food To rest the pancreas and reduce secretion of pancreatic enzymes, NPO status must be initiated and maintained during the acute phase of pancreatitis. This is the priority intervention to address after the client's pain has been treated.

A nurse is preparing a client who is scheduled to undergo paracentesis. Into which of the following positions should the nurse assist the client for this procedure?

High-Fowler's Sitting upright facilitates pooling of peritoneal fluid for easier drainage.