Hepatic & Biliary NCLEX Questions

A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expected assessment finding? 1. Malaise 2. Dark stools 3. Weight gain 4. Left upper quadrant discomfort

1Rationale: Hepatitis causes gastrointestinal symptoms such as anorexia, nausea, right upper quadrant discomfort, and weight loss.Fatigue and malaise are common. Stools will be light- or clay-colored if conjugated bilirubin is unable to flow out of the liver becauseof inflammation or obstruction of the bile ducts.Test-Taking Strategy: Focus on the subject, expected assessment findings. Recalling the function of the liver will direct you to thecorrect option. Remember that fatigue and malaise are common.Review: The signs and symptoms of hepatitisLevel of Cognitive Ability: AnalyzingClient Needs: Physiological IntegrityIntegrated Process: Nursing Process—AssessmentContent Area: Adult Health—GastrointestinalPriority Concepts: Clinical Judgment; InfectionReference: Ignatavicius, Workman (2013), pp. 1305-1306.

A client is admitted to the hospital with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? 1. Select foods high in fat. 2. Increase intake of fluids, including juices. 3. Eat a good supper when anorexia is not as severe. 4. Eat less often, preferably only three large meals daily.

2Rationale: Although no special diet is required to treat viral hepatitis, it is generally recommended that clients consume a low-fat dietas fat may be tolerated poorly because of decreased bile production. Small, frequent meals are preferable and may even preventnausea. Frequently, appetite is better in the morning, so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to3000 mL/day that includes nutritional juices is also important.Test-Taking Strategy: Focus on the subject, a diet for viral hepatitis. Think about the pathophysiology associated with hepatitis andfocus on the client's complaints to direct you to the correct option.Review: Measures to provide adequate nutrition in the client with hepatitisLevel of Cognitive Ability: ApplyingClient Needs: Physiological IntegrityIntegrated Process: Teaching and LearningContent Area: Adult Health—GastrointestinalPriority Concepts: Client Education; InfectionReferences: Schlenker (2011), pp. 464-465; Swearingen (2012), p. 427.

Select all the types of viral Hepatitis that have preventive vaccines available in the United States? A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

A and B. Currently there is only a vaccine for Hepatitis A and B in the U.S.

A patient is diagnosed with Hepatitis D. What statement is true about this type of viral Hepatitis? Select all that apply: A. The patient will also have the Hepatitis B virus. B. Hepatitis D is most common in Southern and Eastern Europe, Mediterranean, and Middle East. C. Prevention of Hepatitis D includes handwashing and the Hepatitis D vaccine. D. Hepatitis D is most commonly transmitted via the fecal-oral route.

A and B. These are true statements about Hepatitis D. Prevention for Hepatitis D includes handwashing and the Hepatitis B vaccine (since it occurs only with the Hepatitis B virus). It is transmitted via blood.

Which statements are INCORRECT regarding the anatomy and physiology of the liver? Select all that apply: A. The liver has 3 lobes and 8 segments. B. The liver produces bile which is released into the small intestine to help digest fats. C. The liver turns urea, a by-product of protein breakdown, into ammonia. D. The liver plays an important role in the coagulation process.

A and C. The liver has 2 lobes (not 3), and the liver turns ammonia (NOT urea), which is a by-product of protein breakdown, into ammonia. All the other statements are true about liver's anatomy and physiology.

You're providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY? Select all that apply: A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D E. Hepatitis E

A and E. Only Hepatitis A and E cause ACUTE infections...not chronic. Hepatitis B, C, and D can cause both acute and chronic infections.

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? A) Asterixis B) Constructional apraxia C) Fetor hepaticus D) Ataxia

A) Asterixis Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy (Fig. 49-13).

Which type of deficiency results in macrocytic anemia? A) Folic acid B) Vitamin C C) Vitamin K D) Vitamin A

A) Folic acid Folic acid deficiency results in macrocytic anemia. Vitamin C deficiency results in hemorrhagic lesions of scurvy. Vitamin A deficiency results in night blindness and eye and skin changes. Vitamin K deficiency results in hypoprothrombinemia, which is characterized by spontaneous bleeding and ecchymosis.

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

A) Reduce fluid accumulation and venous pressure. Methods of treating portal hypertension aim to reduce fluid accumulation and venous pressure. There is no cure for cirrhosis; treating the esophageal varices is only a small portion of the overall objective. Promoting optimal neurologic function will not reduce portal hypertension.

How is Hepatitis E transmitted? A. Fecal-oral B. Percutaneous C. Mucosal D. Body fluids

A. Fecal-oral

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? A) Thiamine B) Vitamin A C) Riboflavin D) Vitamin K

B) Vitamin A Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.

A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? Select all that apply: A. None because this bilirubin level is normal B. Yellowing of the skin and sclera C. Clay-colored stools D. Bluish discoloration on the flanks of the abdomen E. Dark urine F. Mental status changes

B, C, and E. This is associated with a high bilirubin level. A normal bilirubin level is 1 or less.

A 36-year-old patient's lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as? A. The patient has an active infection of Hepatitis A. B. The patient has recovered from a previous Hepatitis A infection and is now immune to it. C. The patient is in the preicetric phase of viral Hepatitis. D. The patient is in the icteric phase of viral Hepatitis.

B. When a patient has anti-HAV (antibodies of the Hepatitis A virus) and IgG, this means the patient HAD a past infection of Hepatitis A but it is now gone, and the patient is immune to Hepatitis A now. If the patient had anti-HAV and IgM, this means the patient has an active infection of Hepatitis A.

Which enzyme aids in the digestion of fats? A) Amylase B) Secretin C) Lipase D) Trypsin

C) Lipase Lipase is a pancreatic enzyme that aids in the digestion of fats. Amylase aids in the digestion of carbohydrates. Secretin is responsible for stimulating secretion of pancreatic juice. Trypsin aids in the digestion of protein.

Which symptoms will a nurse observe most commonly in clients with pancreatitis? A) increased and painful urination B) black, tarry stools and dark urine C) severe, radiating abdominal pain D) increased appetite and weight gain

C) severe, radiating abdominal pain The most common symptom in clients with pancreatitis is severe midabdominal to upper abdominal pain, radiating to both sides and straight to the back.

Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency? A) Hypoprothrombinemia B) Night blindness C) Beriberi D) Scurvy

D) Scurvy Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason? A) To depress the central nervous system and increase the pain threshold B) To decrease metabolism C) To relieve nausea and vomiting D) To reduce gastric and pancreatic secretions

D) To reduce gastric and pancreatic secretions Anticholinergic medications reduce gastric and pancreatic secretion.

What is the MOST common transmission route of Hepatitis C? A. Blood transfusion B. Sharps injury C. Long-term dialysis D. IV drug use

D. IV drug use is the MOST common transmission route of Hepatitis C.

The nurse is reviewing the prescription for a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions would the nurse expect to be prescribed for the client?Select all that apply. 1. Administer antacids as prescribed. 2. Encourage coughing and deep breathing. 3. Administer anticholinergics as prescribed. 4. Give small, frequent high-calorie feedings. 5. Maintain the client in a supine and flat position. 6. Give meperidine (Demerol) as prescribed for pain.

1, 2, 3, 6Rationale: The client with acute pancreatitis normally is placed on NPO status to rest the pancreas and suppress gastrointestinalsecretions. Because abdominal pain is a prominent symptom of pancreatitis, pain medication such as meperidine is prescribed. Someclients experience lessened pain by assuming positions that flex the trunk, with the knees drawn up to the chest. A side-lying positionwith the head elevated 45 degrees decreases tension on the abdomen and may help ease the pain. The client is susceptible torespiratory infections because the retroperitoneal fluid raises the diaphragm, which causes the client to take shallow, guardedabdominal breaths. Therefore measures such as turning, coughing, and deep breathing are instituted. Antacids and anticholinergicsmay be prescribed to suppress gastrointestinal secretions.Test-Taking Strategy: Focus on the subject, care for the client with acute pancreatitis. Think about the pathophysiology associatedwith pancreatitis and note the word acute. This will assist in selecting the correct options.Review: Acute pancreatitisLevel of Cognitive Ability: AnalyzingClient Needs: Physiological IntegrityIntegrated Process: Nursing Process—AnalysisContent Area: Adult Health—GastrointestinalPriority Concepts: Caregiving; InflammationReferences: Ignatavicius, Workman (2013), pp. 1324-1326; Swearingen (2012), pp. 432, 435.

The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the ammonia level is elevated. Which diet does the nurse anticipate to be prescribed for thisclient? 1. Low-protein diet 2. High-protein diet 3. Moderate-fat diet 4. High-carbohydrate diet

1Rationale: Cirrhosis is a chronic, progressive disease of the liver characterized by diffuse degeneration and destruction ofhepatocytes. Most of the ammonia in the body is found in the gastrointestinal tract. Protein provided by the diet is transported to theliver by the portal vein. The liver breaks down protein, which results in the formation of ammonia. If the client has hepaticencephalopathy, a low-protein diet would be prescribed.Test-Taking Strategy: Focus on the subject, an elevated ammonia level. Recall the physiology of the liver to assist in answering.Also, note that the correct option and option 2 are opposite, which should provide you with the clue that one of these options is correct.Review: Dietary measures for the client with a high ammonia levelLevel of Cognitive Ability: UnderstandingClient Needs: Physiological IntegrityIntegrated Process: Nursing Process—PlanningContent Area: Adult Health—GastrointestinalPriority Concepts: Clinical Judgment; InflammationReference: Lewis et al (2011), p. 1080.

The health care provider has determined that a client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

1Rationale: Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and Dare transmitted most commonly via infected blood or body fluids.Test-Taking Strategy: Note the strategic words most likely. Recalling the modes of transmission of the various types of hepatitis isrequired to answer this question. Remember that hepatitis A is transmitted by the fecal-oral route.Review: Methods of transmission of hepatitisLevel of Cognitive Ability: UnderstandingClient Needs: Safe and Effective Care EnvironmentIntegrated Process: Nursing Process—AssessmentContent Area: Adult Health—GastrointestinalPriority Concepts: Client Education; InfectionReference: Ignatavicius, Workman (2013), p. 1305.

A client has been admitted to the hospital with a diagnosis of acute pancreatitis and the nurse is assessing the client's pain. What type of pain is consistent with this diagnosis? 1. Burning and aching, located in the left lower quadrant and radiating to the hip 2. Severe and unrelenting, located in the epigastric area and radiating to the back 3. Burning and aching, located in the epigastric area and radiating to the umbilicus 4. Severe and unrelenting, located in the left lower quadrant and radiating to the groin

2Rationale: The pain associated with acute pancreatitis is often severe and unrelenting, is located in the epigastric region, and radiatesto the back. The other options are incorrect.Test-Taking Strategy: Noting the word acute will assist in eliminating options 1 and 3 because they are comparable or alike. Fromthe remaining options, recalling the anatomical location of the pancreas will direct you to the correct option.Review: Manifestations of acute pancreatitisLevel of Cognitive Ability: UnderstandingClient Needs: Physiological IntegrityIntegrated Process: Nursing Process—AssessmentContent Area: Adult Health—GastrointestinalPriority Concepts: Inflammation; PainReferences: Ignatavicius, Workman (2013), p. 1323; Swearingen (2012), pp. 430-431.

The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence? 1. Dorsiflex the client's foot. 2. Measure the abdominal girth. 3. Ask the client to extend the arms. 4. Instruct the client to lean forward.

3Rationale: Asterixis is irregular flapping movements of the fingers and wrists when the hands and arms are outstretched, with thepalms down, wrists bent up, and fingers spread. Asterixis is the most common and reliable sign that hepatic encephalopathy isdeveloping. Options 1, 2, and 4 are incorrect.Test-Taking Strategy: Focus on the subject, the procedure for assessment of asterixis. Remember that asterixis is irregular flappingmovements of the fingers and wrists. This will direct you to the correct option.Review: AsterixisLevel of Cognitive Ability: ApplyingClient Needs: Health Promotion and MaintenanceIntegrated Process: Nursing Process—AssessmentContent Area: Adult Health—GastrointestinalPriority Concepts: Clinical Judgment; InflammationReference: Lewis et al (2011), p. 1077.

The nurse has given instructions to a client who has just been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions? 1. "I will continue taking vitamin supplements." 2. "This medication will help lower my cholesterol." 3. "This medication should only be taken with water." 4. "A high-fiber diet is important while taking this medication."

3Rationale: Cholestyramine (Questran) is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problembecause of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acidsequestrants include constipation and decreased vitamin absorption.Test-Taking Strategy: Note the strategic words need for further instructions. These words indicate a negative event queryand ask you to select an option that is an incorrect statement. Note the closed-ended word only in the correct option.Review: The action and side effects of cholestyramine (Questran)Level of Cognitive Ability: EvaluatingClient Needs: Physiological IntegrityIntegrated Process: Teaching and LearningContent Area: Pharmacology—Gastrointestinal MedicationsPriority Concepts: Client Education; SafetyReference: Hodgson, Kizor (2013), p. 229.

The nurse is assessing a client 24 hours following a cholecystectomy. The nurse notes that the T-tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is most appropriate? 1. Clamp the T-tube. 2. Irrigate the T-tube. 3. Document the findings. 4. Notify the health care provider.

3Rationale: Following cholecystectomy, drainage from the T-tube is initially bloody and then turns a greenish-brown color. Thedrainage is measured as output. The amount of expected drainage will range from 500 to 1000 mL/day. The nurse would documentthe output.Test-Taking Strategy: Note the strategic words, most appropriate. Options 1 and 2 can be eliminated because a T-tube is notirrigated and would not be clamped with this amount of drainage. From the remaining options, you must know normal expectedfindings following this surgical procedure.Review: Postoperative assessment findings following cholecystectomyLevel of Cognitive Ability: ApplyingClient Needs: Physiological IntegrityIntegrated Process: Nursing Process—ImplementationContent Area: Adult Health—GastrointestinalPriority Concepts: Clinical Judgment; EliminationReferences: Ignatavicius, Workman (2013), p. 1319; Lewis et al (2011), p. 1100

A client has begun medication therapy with pancrelipase (Pancrease MT,). The nurse evaluates that the medication is having the optimal intended benefit if which effect isobserved? 1. Weight loss 2. Relief of heartburn 3. Reduction of steatorrhea 4. Absence of abdominal pain

3Rationale: Pancrelipase (Pancrease, Creon) is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. Themedication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It isnot used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding indigestion.Test-Taking Strategy: Focus on the subject, intended benefit of the medication and on the name of the medication. Use knowledgeof physiology of the pancreas to assist in directing you to the correct option.Review: Pancrelipase (Pancrease)Level of Cognitive Ability: EvaluatingClient Needs: Physiological IntegrityIntegrated Process: Nursing Process—EvaluationContent Area: Pharmacology—Gastrointestinal MedicationsPriority Concepts: Clinical Judgment; InflammationReferences: Hodgson, Kizor (2013), pp. 894-895; Lehne (2013), p. 1023.

The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography procedure. The nurse determines that the client needs further information if the client makes which statement? 1. "I know I must sign the consent form." 2. "I hope the throat spray keeps me from gagging." 3. "I'm glad I don't have to lie still for this procedure." 4. "I'm glad some IV medication will be given to relax me."

3Rationale: The client does have to lie still for endoscopic retrograde cholangiopancreatography (ERCP), which takes about 1 hour toperform. The client also has to sign a consent form. Intravenous sedation is given to relax the client, and an anesthetic spray is used tohelp keep the client from gagging as the endoscope is passed.Test-Taking Strategy: Note the strategic words needs further information. These words indicate a negative event query andask you to select an option that is incorrect. Invasive procedures require consent, so option 1 can be eliminated. Noting the name ofthe procedure and considering the anatomical location will assist you in eliminating options 2 and 4.Review: Endoscopic retrograde cholangiopancreatographyLevel of Cognitive Ability: EvaluatingClient Needs: Physiological IntegrityIntegrated Process: Teaching and LearningContent Area: Adult Health—GastrointestinalPriority Concepts: Client Education; SafetyReferences: Ignatavicius, Workman (2013), pp. 1187-1188; Pagana, Pagana (2013), pp. 389-390.

The nurse is assessing a client who is experiencing an acute episode of cholecystitis. Where should the nurse anticipate the location of the pain? 1. Right lower quadrant, radiating to the back 2. Right lower quadrant, radiating to the umbilicus 3. Right upper quadrant, radiating to the left scapula and shoulder 4. Right upper quadrant, radiating to the right scapula and shoulder

4Rationale: During an acute episode of cholecystitis, the client may complain of severe right upper quadrant pain that radiates to theright scapula and shoulder. This is determined by the pattern of dermatomes in the body. The other options are incorrect.Test-Taking Strategy: Focus on the subject, the location of pain associated with cholecystitis. Recalling the anatomical location ofthe gallbladder will direct you to the correct option.Review: Characteristics of pain associated with cholecystitisLevel of Cognitive Ability: UnderstandingClient Needs: Physiological IntegrityIntegrated Process: Nursing Process—AssessmentContent Area: Adult Health—GastrointestinalPriority Concepts: Inflammation; PainReference: Swearingen (2012), pp. 399-400.

A client has a PRN prescription for ondansetron (Zofran). For which condition should the nurse administer this medication to the postoperative client? 1. Paralytic ileus 2. Incisional pain 3. Urinary retention 4. Nausea and vomiting

4Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associatedwith chemotherapy. The other options are incorrect.Test-Taking Strategy: Focus on the subject, the action of ondansetron. Recalling that this medication is an antiemetic will direct youto the correct option.Review: Ondansetron (Zofran)Level of Cognitive Ability: ApplyingClient Needs: Physiological IntegrityIntegrated Process: Nursing Process—ImplementationContent Area: Pharmacology—Gastrointestinal MedicationsPriority Concepts: Clinical Judgment; Fluid and Electrolyte BalanceReference: Lehne (2013), pp. 1010-1011.

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? A) "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." B) "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." C) "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." D) "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated."

A) "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." If pain occurs in the right shoulder or scapular area (from migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure), the nurse may recommend using a heating pad for 15 to 20 minutes hourly, sitting up in a bed or chair, or walking.

A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply. A) Ammonia conversion B) Glucose metabolism C) Carbohydrate metabolism D) Protein metabolism E) Zinc storage

A) Ammonia conversion B) Glucose metabolism D) Protein metabolism Functions of the liver include the metabolism of glucose, protein, fat, and drugs; conversion of ammonia; storage of vitamins and iron; formation of bile; and excretion of bilirubin. The liver is not responsible for the metabolism of carbohydrates or the storage of zinc.

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply. A) Enlarged liver size B) Excess storage of vitamin C C) Hemorrhoids D) Accelerated behaviors and mental processes E) Ascites

A) Enlarged liver size C) Hemorrhoids E) Ascites Early in the course of cirrhosis, the liver tends to be large, and the cells are loaded with fat. The liver is firm and has a sharp edge that is noticeable on palpation. Portal obstruction and ascites, late manifestations of cirrhosis, are caused partly by chronic failure of liver function and partly by obstruction of the portal circulation. The obstruction to blood flow through the liver caused by fibrotic changes also results in the formation of collateral blood vessels in the GI system and shunting of blood from the portal vessels into blood vessels with lower pressures. These distended blood vessels form varices or hemorrhoids, depending on their location. Because of inadequate formation, use, and storage of certain vitamins (notably vitamins A, C, and K), signs of deficiency are common, particularly hemorrhagic phenomena associated with vitamin K deficiency. Additional clinical manifestations include deterioration of mental and cognitive function with impending hepatic encephalopathy and hepatic coma, as previously described.

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

A) Hepatitis C increases a person's risk for liver cancer. Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? A) Reposition the client every 2 hours. B) Withhold oral feedings for the client. C) Monitor pulse oximetry every hour. D) Instruct the client to avoid coughing.

A) Reposition the client every 2 hours. Repositioning the client every 2 hours minimizes the risk of atelectasis in a client who is being treated for pancreatitis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring the pulse oximetry helps show changes in respiratory status and promote early intervention, but it would do little to minimize the risk of atelectasis. Withholding oral feedings limits the reflux of bile and duodenal contents into the pancreatic duct.

The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient? A) Respiratory assessment related to increased thoracic pressure B) Peripheral vascular assessment related to immobility C) Skin assessment related to increase in bile salts D) Urinary output related to increased sodium retention

A) Respiratory assessment related to increased thoracic pressure If a patient with ascites from liver dysfunction is hospitalized, nursing measures include assessment and documentation of intake and output (I&O;), abdominal girth, and daily weight to assess fluid status. The nurse also closely monitors the respiratory status because large volumes of ascites can compress the thoracic cavity and inhibit adequate lung expansion. The nurse monitors serum ammonia, creatinine, and electrolyte levels to assess electrolyte balance, response to therapy, and indications of encephalopathy.

Which of the following is the most effective strategy to prevent hepatitis B infection? A) Vaccine B) Barrier protection during intercourse C) Covering open sores D) Avoid sharing toothbrushes

A) Vaccine The most effective strategy to prevent hepatitis B infection is through vaccination. Recommendations to prevent transmission of hepatitis B include vaccination of sexual contacts of individuals with chronic hepatitis, use of barrier protection during sexual intercourse, avoidance of sharing toothbrushes, razors with others, and covering open sores or skin lesions.

A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? A) Vitamin K deficiency B) Folic acid deficiency C) Vitamin A deficiency D) Riboflavin deficiency

A) Vitamin K deficiency Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency leads to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Pyridoxine deficiency results in skin and mucous membrane lesions and neurologic changes. Vitamin C deficiency results in the hemorrhagic lesions of scurvy. Vitamin K deficiency results in hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses. Folic acid deficiency results in macrocytic anemia.

Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply:* A. Thrombocytopenia B. Vision changes C. Increased PT/INR D. Leukopenia

A, C, and D. A patient with an enlarged spleen (splenomegaly) due to cirrhosis can experience thrombocytopenia (low platelet count), increased PT/INR (means it takes the patient a long time to stop bleeding), and leukopenia (low white blood cells). The spleen stores platelets and WBCs. An enlarged spleen can develop due to portal hypertension, which causes the platelets and WBCs to become stuck inside the spleen due to the increased pressure in the hepatic vein (hence lowering the count and the body's access to these important cells for survival).

You're providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct: Select all that apply* A. Excessive coughing B. Sleeping on the back C. Drinking juice D. Alcohol consumption E. Straining during a bowel movement F. Vomiting

A, D, E, and F. Esophageal varices are dilated vessels that are connected from the throat to the stomach. They can become enlarged due to portal hypertension in cirrhosis and can rupture (this is a medical emergency). The patient should avoid activities that could rupture these vessels, such as excessive cough, vomiting, drinking alcohol, and constipation (straining increases thoracic pressure.)

Select all the signs and symptoms associated with Hepatitis? A. Arthralgia B. Bilirubin 1 mg/dL C. Ammonia 15 mcg/dL D. Dark urine E. Vision changes F. Yellowing of the sclera G. Fever H. Loss of appetite

A, D, F, G, and H. The bilirubin and ammonia levels are normal in these options, but they would be abnormal in Hepatitis. A normal bilirubin is 1 or less, and a normal ammonia is 15-45 mcg/dL.

A patient has lab work drawn and it shows a positive HBsAg. What education will you provide to the patient? A. Avoid sexual intercourse or intimacy such as kissing until blood work is negative. B. The patient is now recovered from a previous Hepatitis B infection and is now immune. C. The patient is not a candidate from antiviral or interferon medications. D. The patient is less likely to develop a chronic infection.

A. A positive HBsAg (hepatitis B surface antigen) indicates an active Hepatitis B infection. Therefore, the patient should avoid sexual intercourse and other forms of intimacy until their HBsAg is negative.

A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient?* A. Beef tips and broccoli rabe B. Pasta noodles and bread C. Cucumber sandwich with a side of grapes D. Fresh salad with chopped water chestnuts

A. Patients who are experiencing hepatic encephalopathy are having issues with toxin build up in the body, specifically ammonia. Remember that ammonia is the byproduct of protein breakdown, and normally the liver can take the ammonia from the protein breakdown and turn it into urea (but if the cirrhosis is severe enough this can't happen). Therefore, the patient should consume foods LOW in protein until the encephalopathy subsides. Option A is very high in protein while the others are low in protein. Remember meats, legumes, eggs, broccoli rabe, certain grains etc. are high in protein.

A patient with viral Hepatitis states their flu-like symptoms have subsided. However, they now have yellowing of the skin and sclera along with dark urine. Based on this finding, this is what phase of Hepatitis? A. Icteric B. Posticteric C. Preicteric D. Convalescent

A. The Preicteric (prodromal) Phase: flulike symptoms...joint pain, fatigue, nausea vomiting, abdominal pain change in taste, liver enzymes and bilirubin increasing....Icteric Phase: decrease in the flu-like symptoms but will have jaundice and dark urine (buildup of bilirubin) yellowing of skin and white part of the eyeball, clay-colored stool (bilirubin not going to stool to give it's normal brown color) enlarged liver and pain in this area....Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to normal

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change? A. Ammonia 100 mcg/dL B. Bilirubin 7 mg/dL C. ALT 56 U/L D. AST 10 U/L

A. When ammonia levels become high (normal 15-45 mcg/dL) it affects brain function. Therefore, the nurse would see mental status changes in a patient with this ammonia level.

The physician orders Lactulose 30 mL by mouth per day for a patient with cirrhosis. What findings below demonstrates the medication is working effectively? Select all that apply:* A. Decrease albumin levels B. Decrease in Fetor Hepaticus C. Patient is stuporous. D. Decreased ammonia blood level E. Presence of asterixis

B and D. A patient with cirrhosis may experience a complication called hepatic encephalopathy. This will cause the patient to become confused (they may enter into a coma), have pungent, musty smelling breath (fetor hepaticus), asterixis (involuntary flapping of the hands) etc. This is due to the buildup of ammonia in the blood, which affects the brain. Lactulose can be prescribed to help decrease the ammonia levels. Therefore, if the medication is working properly to decrease the level of ammonia the patient would have improving mental status (NOT stuporous), decreased ammonia blood level, decreasing or absence of asterixis, and decreased ammonia blood level.

During the posticteric phase of Hepatitis the nurse would expect to find? Select all that apply: A. Increased ALT and AST levels along with an increased bilirubin level B. Decreased liver enzymes and bilirubin level C. Flu-like symptoms D. Resolved jaundice and dark urine

B and D. Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal brown color, liver enzymes and bilirubin decrease to normal

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? A) "You must have the second one in 6 months and the third in 1 year." B) "You must have the second one in 1 month and the third in 6 months." C) "You must have the second one in 1 year and the third the following year." D) "You must have the second one in 2 weeks and the third in 1 month."

B) "You must have the second one in 1 month and the third in 6 months." Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.

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

B) Assisting the client to turn, cough, and deep breathe every 2 hours Assessment should focus on the client's respiratory status. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The other nursing actions are also important, but are not as high a priority as ensuring adequate ventilation.

When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? A) Black and tarry B) Clay-colored or whitish C) Yellow-green D) Blood tinged

B) Clay-colored or whitish Many clients report passing clay-colored or whitish stools as a result of no bile in the gastrointestinal tract. The other stool colors would not be absolute indicators of cirrhosis of the liver but may indicate other GI tract disorders.

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes? A) Ingestion of foods high in sugar B) Dysfunction of the pancreatic islet cells C) Renal failure D) Inability for the liver to reabsorb serum glucose

B) Dysfunction of the pancreatic islet cells Diabetes mellitus resulting from dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents. The hazard of severe hypoglycemia with alcohol consumption is stressed to the client and family. When secondary diabetes develops in a client with chronic pancreatitis, the client experiences increased appetite, thirst, and urination. A standard treatment with pancreatitis is to make the client NPO. The dysfunction is related to the pancreas, not the liver.

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? A) Colonoscopy B) Endoscopic retrograde cholangiopancreatography (ERCP) C) Abdominal x-ray D) Cholecystectomy

B) Endoscopic retrograde cholangiopancreatography (ERCP) ERCP locates stones that have collected in the common bile duct. A colonoscopy will not locate gallstones but only allows visualization of the large intestine. Abdominal x-ray is not a reliable locator of gallstones. A cholecystectomy is the surgical removal of the gallbladder.

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: A) Cystic duct B) Gallbladder C) Duodenum D) Common bile duct

B) Gallbladder The gallbladder functions as a storage depot for bile.

A client with suspected biliary obstruction due to gallstones reports changes to the color of his stools. Which stool color does the nurse recognize as common to biliary obstruction? A) Red B) Gray C) Black D) Green

B) Gray A gray-white stool color is common with a biliary obstruction because the stool is no longer colored with bile pigments.

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

B) It visualizes the gallbladder and bile duct. The cholecystogram is a diagnostic imaging test used to visualize the gallbladder and bile duct. The celiac axis arteriography visualizes the liver and pancreas. Ultrasonography shows the sizes of the abdominal organs and detects any masses. The endoscopic retrograde cholangiopancreatography (ERCP) visualizes the biliary structures and pancreas via endoscopy

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

B) Relieving abdominal pain The predominant clinical feature of acute pancreatitis is abdominal pain, which usually reaches peak intensity several hours after onset of the illness. Therefore, relieving abdominal pain is the nurse's primary goal. Because acute pancreatitis causes nausea and vomiting, the nurse should try to prevent fluid volume deficit, not overload. The nurse can't help the client achieve adequate nutrition or understand the disease and its treatment until the client is comfortable and no longer in pain.

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate? A) Providing the client with plenty of P.O. fluids B) Reserving an antecubital site for a peripherally inserted central catheter (PICC) C) Limiting I.V. fluid intake according to the physician's order D) Providing generous servings at mealtime

B) Reserving an antecubital site for a peripherally inserted central catheter (PICC) Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve the antecubital site for a PICC, which enables the client to receive long-term total parenteral nutrition. Clients in the acute stages of pancreatitis also require large volumes of I.V. fluids to compensate for fluid loss.

In what location would the nurse palpate for the liver? A) Left upper quadrant B) Right upper quadrant C) Right lower quadrant D) Left lower quadrant

B) Right upper quadrant The liver may be palpable in the right upper quadrant. A palpable liver presents as a firm, sharp ridge with a smooth surface.

A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for? A) Vasopressin (Pitressin) B) Transjugular intrahepatic portosystemic shunting (TIPS) C) Balloon tamponade D) Sclerotherapy

B) Transjugular intrahepatic portosystemic shunting (TIPS) A TIPS procedure (see Fig. 49-8) is indicated for the treatment of an acute episode of uncontrolled variceal bleeding refractory to pharmacologic or endoscopic therapy. In 10% to 20% of patients for whom urgent band ligation or sclerotherapy and medications are not successful in eradicating bleeding, a TIPS procedure can effectively control acute variceal hemorrhage by rapidly lowering portal pressure.

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk? A) Monitor pulse oximetry every hour. B) Use incentive spirometry every hour. C) Withhold analgesics unless necessary. D) Instruct the client to cough only when necessary.

B) Use incentive spirometry every hour. The nurse instructs the client in techniques of coughing and deep breathing and in the use of incentive spirometry to improve respiratory function. The nurse assists the client to perform these activities every hour. Repositioning the client every 2 hours minimizes the risk of atelectasis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring pulse oximetry helps show changes in respiratory status and promotes early intervention, but it would do little to minimize the risk of atelectasis. Withholding analgesics is not an appropriate intervention due to the severe pain associated with pancreatitis.

Select all the ways a person can become infected with Hepatitis B: A. Contaminated food/water B. During the birth process C. IV drug use D. Undercooked pork or wild game E. Hemodialysis F. Sexual intercourse

B, C, E, and F. Hepatitis B is spread via blood and body fluids. It could be transmitted via the birthing process, IV drug use, hemodialysis, or sexual intercourse etc.

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply: A. A 55-year-old male with Hepatitis A. B. An infant who contracted Hepatitis B at birth. C. A 32-year-old female with Hepatitis C who reports using IV drugs. D. A 50-year-old male with alcoholism and Hepatitis D. E. A 30-year-old who contracted Hepatitis E.

B, C, and D. Infants or young children who contract Hepatitis B are at a very high risk of developing chronic Hepatitis B (which is why option B is correct). Option C is correct because most cases of Hepatitis C turn into chronic cases and IV drug use increases this risk even more. Option D is correct because Hepatitis D occurs when Hepatitis B is present and constant usage of alcohol damages the liver. Therefore, the patient is at high risk of developing chronic hepatitis. Hepatitis A and E tend to only cause acute infections....not chronic.

A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply:* A. Increase albumin levels B. Ascites C. Splenomegaly D. Fluid volume deficient E. Esophageal varices

B, C, and E. Portal Hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experience ascites, enlarged spleen "splenomegaly", and esophageal varices etc.

You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient's bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply:* A. Frothy light-colored urine B. Dark brown urine C. Yellowing of the sclera D. Dark brown stool E. Jaundice of the skin F. Bluish mucous membranes

B, C, and E. High bilirubin levels are because the hepatocytes are no longer able to properly conjugate the bilirubin because they are damaged. This causes bilirubin to leak into the blood and urine (rather than entering the bile and being excreted in the stool). Therefore, the bilirubin stays in the blood and will enter the urine. This will cause the patient to experience yellowing of the skin, sclera of the eyes, and mucous membranes ("jaundice") and have dark brown urine. The stools would be CLAY-COLORED not dark brown (remember bilirubin normally gives stool it brown color but it will be absent).

A patient was exposed to Hepatitis B recently. Postexposure precautions include vaccination and administration of HBIg (Hepatitis B Immune globulin). HBIg needs to be given as soon as possible, preferably ___________ after exposure to be effective. A. 2 weeks B. 24 hours C. 1 month D. 7 days

B. HBIg should be given 24 hours after exposure to maximum effectiveness of temporary immunity against Hepatitis B. It would be given within 12 hours after birth to an infant born to a mother who has Hepatitis B.

The liver receives it blood supply from two sources. One of these sources is called the _________________, which is a vessel network that delivers blood _____________ in nutrients but ________ in oxygen.* A. hepatic artery, low, high B. hepatic portal vein, high, low C. hepatic lobule, high, low D. hepatic vein, low, high

B. Majority of the blood flow to the liver comes from the hepatic portal vein. This vessel network delivers blood HIGH in nutrients (lipids, proteins, carbs etc.) from organs that aid in the digestion of food, but the blood is POOR in oxygen. The organs connected to the hepatic portal vein are: small/large intestine, pancreas, spleen, stomach. Rich oxygenated blood comes from the hepatic artery to the liver.

Which patient below is at MOST risk for developing a complication related to a Hepatitis E infection? A. A 45-year-old male with diabetes. B. A 26-year-old female in the 3rd trimester of pregnancy. C. A 12-year-old female with a ventricle septal defect. D. A 63-year-old male with cardiovascular disease.

B. Patients who are in the 3rd trimester of pregnancy are at a HIGH risk of developing a complication related to a Hepatitis E infection.

The liver receives blood from two sources. The _____________ is responsible for pumping blood rich in nutrients to the liver.* A. hepatic artery B. hepatic portal vein C. mesenteric artery D. hepatic iliac vein

B. The liver receives blood from two sources. The hepatic portal vein is responsible for pumping blood rich in nutrients to the liver.

While providing mouth care to a patient with late-stage cirrhosis, you note a pungent, sweet, musty smell to the breath. This is known as:* A. Metallic Hepatico B. Fetor Hepaticus C. Hepaticoacidosis D. Asterixis

B. Fetor Hepaticus

Which of the following is NOT a common source of transmission for Hepatitis A? Select all that apply: A. Water B. Food C. Semen D. Blood

C and D. The most common source for transmission of Hepatitis A is water and food.

You're providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? Select all that apply: A. "Take acetaminophen as needed for pain." B. "Eat large meals that are spread out through the day." C. "Follow a diet low in fat and high in carbs." D. "Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product." E. "Perform aerobic exercises daily to maintain strength."

C and D. The patient should NOT take acetaminophen (Tylenol) due to its effective on the liver. The patient should eat small (NOT large), but frequent meals...this may help with the nausea. The patient should rest (not perform aerobic exercises daily) because this will help with liver regeneration.

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct? A) "Maintain a high-fat diet and drink at least 3 L of fluid a day." B) "Maintain a high-fat, high-carbohydrate diet." C) "Maintain a high-carbohydrate, low-fat diet." D) "Maintain a high-sodium, high-calorie diet."

C) "Maintain a high-carbohydrate, low-fat diet." A client with a history of pancreatitis should avoid foods and beverages that stimulate the pancreas, such as fatty foods, caffeine, and gas-forming foods; should avoid eating large meals; and should eat plenty of carbohydrates, which are easily metabolized. Therefore, the only correct instruction is to maintain a high-carbohydrate, low-fat diet. An increased sodium or fluid intake isn't necessary because chronic pancreatitis isn't associated with hyponatremia or fluid loss.

An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is: A) Dextromethorphan B) Benadryl C) Acetaminophen D) Ibuprofen

C) Acetaminophen Although any medication can affect liver function, use of acetaminophen (found in many over-the-counter medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Other medications commonly associated with liver injury include anesthetic agents, medications used to treat rheumatic and musculoskeletal disease, antidepressants, psychotropic medications, anticonvulsants, and antituberculosis agents.

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

C) Acute pain related to biliary spasms The chief symptom of cholecystitis is abdominal pain or biliary colic. Typically, the pain is so severe that the client is restless and changes positions frequently to find relief. Therefore, the nursing diagnosis of Acute pain related to biliary spasms takes highest priority. Until the acute pain is relieved, the client can't learn about prevention, may continue to experience anxiety, and can't address nutritional concerns.

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

C) Change in the client's handwriting and/or cognitive performance The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. The client will appear confused and unkempt and have altered mood and sleep patterns. Neurologic status should be assessed frequently. Mental status is monitored by the nurse keeping the client's daily record of handwriting and arithmetic performance. The nurse should report any change in mental status immediately. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis.

A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder? A) Sepsis B) Disseminated intravascular coagulopathy C) Edema and inflammation D) Pleural effusion

C) Edema and inflammation Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas. Minimal organ dysfunction is present, and return to normal function usually occurs within 6 months.

Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? A) Mashed potatoes B) White rice C) Hot roast beef sandwich with gravy D) Vanilla pudding

C) Hot roast beef sandwich with gravy The diet immediately after an episode of acute cholecystitis is initially limited to low-fat liquids. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, bread, and coffee or tea may be added as tolerated. The client should avoid fried foods such as fried chicken, because fatty foods may bring on an episode of cholecystitis.

When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? A) Provide the client with nonprescription laxatives. B) Ask the client about food intake. C) Measure abdominal girth according to a set routine. D) Report the condition to the physician immediately.

C) Measure abdominal girth according to a set routine. If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? A) Ascites and orthopnea B) Dyspnea and fatigue C) Purpura and petechiae D) Gynecomastia and testicular atrophy

C) Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? A) lavage B) gavage C) decompression D) instillation

C) decompression Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting. Instillations in a nasogastric tube after surgery are done when necessary to promote patency; this is not the most common purpose of a nasogastric tube after surgery. Gavage is contraindicated after abdominal surgery until peristalsis returns. Lavage after surgery may be done to promote hemostasis in the presence of gastric bleeding, but this is not the most common purpose of a nasogastric tube after surgery.

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

C) radical pancreatoduodenectomy Radical pancreatoduodenectomy involves removing the head of the pancreas, resecting the duodenum and stomach, and redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the jejunum. Cholecystojejunostomy is a rerouting of the pancreatic and biliary drainage systems, which may be done to relieve obstructive jaundice. This measure is considered palliative only. A pancreatectomy is the surgical removal of the pancreas. A pancreatectomy may be total, in which case the entire organ is removed, usually along with the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach. A distal pancreatectomy is a surgical procedure to remove the bottom half of the pancreas.

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient's hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings?* A. Decreased magnesium level B. Increased calcium level C. Increased ammonia level D. Increased creatinine level

C. Based on the assessment findings and the fact the patient has cirrhosis, the patient is experiencing hepatic encephalopathy. This is due to the buildup of toxins in the blood, specifically ammonia. The flapping motion of the hands is called "asterixis". Therefore, an increased ammonia level would confirm these abnormal assessment findings.

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis? A. Vaccination B. Proper disposal of needles C. Hand hygiene D. Blood and organ donation screening

C. Hand hygiene can help prevent all types of viral hepatitis. However, not all types of viral Hepatitis have a vaccine available or are spread through needle sticks or blood/organs donations. Remember Hepatitis A and E are spread only via fecal-oral routes.

The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful? A. Bilirubin <1 mg/dL B. ALT 8 U/L C. Ammonia 16 mcg/dL D. AST 10 U/L

C. Lactulose is ordered to decrease a high ammonia level. It will cause excretion of ammonia via the stool. A normal ammonia level would indicate the medication was successful (normal ammonia level 15-45 mcg/dL).

Which of the following is NOT a role of the liver?* A. Removing hormones from the body B. Producing bile C. Absorbing water D. Producing albumin

C. The liver does not absorb water. The intestines are responsible for this function.

A patient with Hepatitis A asks you about the treatment options for this condition. Your response is? A. Antiviral medications B. Interferon C. Supportive care D. Hepatitis A vaccine

C. There is no current treatment for Hepatitis A but supportive care and rest. Treatments for the other types of Hepatitis such as B, C, and D include antiviral or interferon (mainly the chronic cases) along with rest.

A patient is prescribed Peginterferon alfa-2a. The nurse will prepare to administer this medication what route? A. Oral B. Intramuscular C. Subcutaneous D. Intravenous

C. This medication is administered subq.

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

D) Administering morphine I.V. as ordered The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

Which is an age-related change of the hepatobiliary system? A) Decreased prevalence of gallstones B) Increased drug clearance capability C) Enlarged liver D) Decreased blood flow

D) Decreased blood flow Age-related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gall stones, and a steady decrease in the size and weight of the liver.

When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions? A) Placing the patient in the prone position B) Perform chest physiotherapy C) Suction the patient every 4 hours D) Frequent changes of positions

D) Frequent changes of positions Frequent changes of position are necessary to prevent atelectasis and pooling of respiratory secretions.

Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels? A) Dry mouth, which makes the client thirsty B) Acetone in the urine C) High glucose concentration in the blood D) Frequent vomiting, leading to loss of fluid volume

D) Frequent vomiting, leading to loss of fluid volume Fluid and electrolyte disturbances are common complications because of nausea, vomiting, movement of fluid from the vascular compartment to the peritoneal cavity, diaphoresis, fever, and the use of gastric suction. The nurse assesses the client's fluid and electrolyte status by noting skin turgor and moistness of mucous membranes. The nurse weighs the client daily and carefully measures fluid intake and output, including urine output, nasogastric secretions, and diarrhea.

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? A) Portal hypertension B) Asterixis C) Cirrhosis D) Hepatic encephalopathy

D) Hepatic encephalopathy Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with an elevated ammonia concentration that produces changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? A) Warm moist skin B) Polyuria C) Bradycardia D) Hypotension

D) Hypotension Signs of potential hypovolemia include cool, clammy skin; tachycardia; decreased blood pressure; and decreased urine output.

The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? A) Kanamycin B) Spironolactone C) Cholestyramine D) Lactulose

D) Lactulose Lactulose is administered to detoxify ammonium and to act as an osmotic agent, drawing water into the bowel, which causes diarrhea in some clients. Potassium-sparing diuretics such as spironolactone are used to treat ascites. Cholestyramine is a bile acid sequestrant and reduces pruritus. Kanamycin decreases intestinal bacteria and decreases ammonia but does not act as an osmotic agent.

Clinical manifestations of common bile duct obstruction include all of the following except: A) Clay-colored feces B) Jaundice c) Pruritus D) Light-colored urine

D) Light-colored urine The excretion of the bile pigments by the kidneys gives the urine a very dark color. The feces, no longer colored with bile pigments, are grayish, like putty, or clay-colored. The symptoms may be acute or chronic. Epigastric distress, such as fullness, abdominal distention, and vague pain in the right upper quadrant of the abdomen, may occur. If it goes untreated jaundice and pruritus can occur.

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? A) Serum potassium level of 3.5 mEq/L B) Serum sodium level of 135 mEq/L C) Blood pH of 7.25 D) Loss of 2.2 lb (1 kg) in 24 hours

D) Loss of 2.2 lb (1 kg) in 24 hours Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system? A) Carry out wound care as prescribed. B) Administer enteral or parenteral nutrition. C) Withhold oral feedings. D) Maintain the client in a semi-Fowler's position.

D) Maintain the client in a semi-Fowler's position. The nurse maintains the client in the semi-Fowler's position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. Respiratory distress and hypoxia are common, and the client may develop diffuse pulmonary infiltrates, dyspnea, tachypnea, and abnormal blood gas values. The client who has undergone surgery may have multiple drains or an open surgical incision and is at risk for skin breakdown and infection. Oral food or fluid intake is not permitted; therefore, enteral or parenteral feedings may be prescribed.

A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal? A) Relieving the client's anxiety B) Controlling bleeding C) Maintaining fluid volume D) Maintaining the airway

D) Maintaining the airway Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway can be compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease? A) Raise all four side rails on the bed B) Apply soft wrist restraints C) Prevent visitors, so as not to agitate the client D) Pad the side rails on the bed

D) Pad the side rails on the bed Padding the side rails can reduce injury if the client becomes agitated or restless. Restraints would not be an initial measure to implement. Four side rails are considered a restraint, and this would not be an initial measure to implement. Family and friends generally assist in calming a client.

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? A) Serum bilirubin B) Serum calcium C) Serum potassium D) Serum amylase

D) Serum amylase Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. Serum amylase and lipase concentrations are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but the serum lipase concentration may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.

The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? A) Acetazolamide (Diamox) B) Furosemide (Lasix) C) Bumetanide (Bumex) D) Spironolactone (Aldactone)

D) Spironolactone (Aldactone) Potassium-sparing diuretic agents such as spironolactone or triamterene (Dyrenium) may be indicated to decrease ascites, if present; these diuretics are preferred because they minimize the fluid and electrolyte changes commonly seen with other agents.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? A) The client is avoiding the nurse. B) The client is relaxed and not in pain. C) The client didn't take his morning dose of lactulose (Cephulac). D) The client's hepatic function is decreasing.

D) The client's hepatic function is decreasing. The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

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

D) The patient has developed peritonitis. Abdominal guarding is present. A rigid or board-like abdomen may develop and is generally an ominous sign, usually indicating peritonitis (Privette et al., 2011).

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

D) To avoid inflammation of the pancreas Pancreatic secretion is increased by food and fluid intake and may cause inflammation of the pancreas.

The digestion of carbohydrates is aided by A) secretin. B) lipase. C) trypsin. D) amylase.

D) amylase. Amylase is secreted by the exocrine pancreas. Lipase aids in the digestion of fats. Trypsin aids in the digestion of proteins. Secretin is the major stimulus for increased bicarbonate secretion from the pancreas.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: A) elevated liver enzymes and low serum protein level. B) subnormal clotting factors and platelet count. C) elevated blood urea nitrogen and creatinine levels and hyperglycemia. D) subnormal serum glucose and elevated serum ammonia levels.

D) subnormal serum glucose and elevated serum ammonia levels. In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: A) circumoral pallor. B) light amber urine. C) black, tarry stools. D) yellow sclerae.

D) yellow sclerae. Yellow sclerae are an early sign of jaundice, which occurs when the common bile duct is obstructed. Urine normally is light amber. Circumoral pallor and black, tarry stools don't occur in common bile duct obstruction; they are signs of hypoxia and GI bleeding, respectively.

________ reside in the liver and help remove bacteria, debris, and old red blood cells.* A. Hepatocytes B. Langerhan cells C. Enterocytes D. Kupffer cells

D. Kupffer cells perform this function and are one of the two types of cells found in the liver lobules (the functional units of the liver). These cells play a role in helping the hepatocytes turn parts of the old red blood cells into bilirubin.

A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is? A. Blood B. Percutaneous C. Mucosal D. Fecal-oral

D. Hepatitis A is most commonly transmitted via the fecal-oral route.

A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient? A. Inform the patient to notify the physician when signs and symptoms of viral Hepatitis start to appear. B. Reassure the patient the chance of acquiring the virus is very low. C. Inform the patient it is very important to obtain the Hepatitis A vaccine immediately to prevent infection. D. Inform the patient to promptly go to the local health department to receive immune globulin.

D. Since the patient was exposed to Hepatitis A, the patient would need to take preventive measures to prevent infection because infection is possible. The patient should not wait until signs and symptoms appear because the patient can be contagious 2 weeks BEFORE signs and symptoms appear. The vaccine would not prevent Hepatitis A from this exposure, but from possible future exposures because it takes the vaccine 30 days to start working. The best answer is option D. The patient would need to receive immune globulin to provide temporary immunity within 2 weeks of exposure.

A patient has completed the Hepatitis B vaccine series. What blood result below would demonstrate the vaccine series was successful at providing immunity to Hepatitis B? A. Positive IgG B. Positive HBsAg C. Positive IgM D. Positive anti-HBs

D. A positive anti-HBs (Hepatitis B surface antibody) indicates either a past infection of Hepatitis B that is now cleared and the patient is immune, OR that the vaccine has been successful at providing immunity. A positive HBsAg (Hepatitis B surface antigen) indicates an active infection.

A 45 year old male has cirrhosis. The patient reports concern about the development of enlarged breast tissue. You explain to the patient that this is happening because?* A. The liver cells are removing too much estrogen from the body which causes the testicles to produce excessive amounts of estrogen, and this leads to gynecomastia. B. The liver is producing too much estrogen due to the damage to the liver cells, which causes the level to increase in the body, and this leads to gynecomastia. C. The liver cells are failing to recycle estrogen into testosterone, which leads to gynecomastia. D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

Which condition is NOT a known cause of cirrhosis?* A. Obesity B. Alcohol consumption C. Blockage of the bile duct D. Hepatitis C E. All are known causes of cirrhosis

E. All of these conditions can cause cirrhosis.

TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and symptoms appear and 1-3 weeks after the symptoms appear. True False

True