Liver, Gallbladder, and Pancreas

A student accepted into a nursing program must begin receiving the hep 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 2 wks and third in 1 month B. You must have the second one in 1mo and the third in 6mos C. You must have the second one in 6mos and the third in 1 year D. You must have the second one in 1 year and the third the following year

B. You must have the second one in 1mo and the third in 6mos

A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the following findings is the priority to report? A. HX of cholelithiasis B. Elevated serum amylase level C. Decrease in bowel sounds D. Hand spasms present when blood pressure is checked.

D. Hand spasms present when blood pressure is checked. The greatest risk to the client is ECG changes and hypotension from hypocalcemia. Hand spasms when taking blood pressure is a manifestation of hypocalcemia.

The nurse is caring for a pt with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin-aldosterone and sympathetic nervous system and decrease responsiveness to diuretic therapy? A. Prone B. Supine C. Left lateral Sims D. Upright

D. Upright

A nurse is teaching a client who has hep B about home care. Which of the following instructions should the nurse include in the teaching? (Select all that apply) A. Limit physical activity B. Avoid alcohol C. Take acetaminophen D. Wear a mask when in public places E. Eat small frequent meals.

A. Limit physical activity B. Avoid alcohol E. Eat small frequent meals.

A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take? A. Instruct the client to chew the medication before swallowing B. Offer a glass of water following the medication administration. C. Administer the medication 30 min before meals D. Sprinkle the contents on peanut butter.

B. Offer a glass of water following the medication administration.

A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? A. Serum amylase 80 units B. WBC 9,000 C. Direct bilirubin 2.1 D. Alkaline phosphates 25 units

C. Direct bilirubin 2.1 The nurse should expect the client who has cholelithiasis to have an elevated direct bilirubin level if the bile duct is obstructed. A direct bilirubin level of 2.1 mg/dL is greater than the expected reference rang.

A nurse is assessing a client who has pancreatitis. Which of the following actions should the nurse take to assess the presence of Cullen's sign? A. Tap lightly at the costovertebral margin on the client's back B. Palpate the right lower quadrant C. Inspect the skin around the umbilicus D. Auscultate the area below the scapula

C. Inspect the skin around the umbilicus

A nurse is caring for a patient who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? (Select all that apply) A. Measure the urine output every 8 hours B. Assess and document VS every 4 hours C. Measure the abdominal girth daily D. Perform daily weights E. Monitor number of bowel movements per day

C. Measure the abdominal girth daily D. Perform daily weights

A nurse is reviewing a new prescription for ursodiol with a client who has cholelithiasis. Which of the following information should the nurse include in the teaching? A. This medication is used to decrease acute biliary pain. B. This medication requires thyroid function monitoring every 6 months. C. This medication is not recommended for client who have diabetes mellitus. D. This medication dissolves gallstones gradually over a period of up to 2 years.

D. This medication dissolves gallstones gradually over a period of up to 2 years. ursodiol is a bile acid that gradually dissolves cholesterol based gall stones. the medication can be taken for up to 2 years.

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (select all that apply) A. Diuretic B. Beta blocking agent C. Opioid analgesic D. Lactulose E. Sedative

A. Diuretic B. Beta blocking agent D. Lactulose

A nurse is reviewing a nutrition teaching for a client who has cholecystitis. The nurse should identify that which of the following food choices can trigger cholecystitis? A. Brownie with nuts B. Bowl of mixed fruit C. Grilled turkey D. Baked potato

A. Brownie with nuts

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

A. Respiratory assessment related to increased thoracic pressure

A pt is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observed they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis? A. The physician will use an ultrasound guided paracentesis B. The physician will not perform the procedure C. The physician will proceed with the paracentesis D. The physician will have the nurse administer packed red blood cells prior to the paracentesis

A. The physician will use an ultrasound guided paracentesis

The nurse is concerned about potassium loss when diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? A. Furosemide B. Spironlactone C. Acetazolamde D. Bumetanide

B. Spironlactone

The nurse is educating a patient with cirrhosis about the importance of maintaining a low sodium diet. What food item would be permitted on a low sodium diet? A. Peanut butter B. A pear C. Hot dog D. Sliced Ham

B. A pear

A nurse is assessing a client who has advanced cirrhosis. The nurse should ID which of the following findings as indicators of hepatic encephalopathy? (Select all that apply) A. Anorexia B. Change in orientation C. Asterixis D. Ascites E. Fetor hepaticus

B. Change in orientation C. Asterixis- coarse tremor of wrists and fingers E. Fetor hepaticus- fruity breath odor

A pt who had a recent myocardial infarction was brought to the ER with bleeding esophageal varices and is presently receiving fluid resuscitation. What first line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices? A. Vasopressin B. Epinephrine C. Octreotide D. Glucagon

C. Octreotide

A pt 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 pt may be experiencing? A. Riboflavin B. Folic acid C. Vit A D. Vit K

C. Vit A

A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? (select all that apply) A. I plan to eat small, frequent meals B. I will eat easy to digest foods with limited spice C. I will used skim milk when cooking D. I plan to drink regular cola E. I will limit alcohol intake to two drinks per day.

A. I plan to eat small, frequent meals B. I will eat easy to digest foods with limited spice C. I will used skim milk when cooking

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

A. Transjugular intrahepatic portosystemic shunting (TIPS)

The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a pt who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate medication overdose? A. watery diarrhea B. vomiting C. Ringing in the ears D. Asterixis

A. watery diarrhea

A nurse is providing discharge teaching for a client who is postoperative following open cholecystectomy with T tube placement. Which of the following instructions should the nurse include in the teaching? (Select all that apply) A. Take baths rather than showers B. Clamp T tube for 1 hour before and after meals C. Keep the drainage system above the level of the abdomen D. Expect to have the T tube removed 3 days postoperatively E Report brown green drainage to the provider

B. Clamp T tube for 1 hour before and after meals C. Keep the drainage system above the level of the abdomen

A nurse is caring for a client who has a new dx of hep C. Which of the following laboratory findings should the nurse expect? A. Presence of immunoglobulin B. Positive EIA test C. Aspartate aminotransferase (AST) 35 units/L D. Alanine aminotransferase (ATL) 15 IU/L

B. Positive EIA test

A pt with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed how long should the nurse withhold food and fluids? A. For 2 hours after the last dose of medication is given B. Until the gag reflex returns C. Until the pt expresses thirst D. For 6 hours after the procedure

B. Until the gag reflex returns

A nurse is completing a preoperative teaching for a client who is scheduled for a laparoscopic cholecystectomy. Which of the following should be included in the teaching? A. The scope will be passed through your rectum B. You might have shoulder pain after surgery C. You will have a Jackson-pratt drain in place after surgery D. You should limit how often you walk for 1 to 2 weeks

B. You might have shoulder pain after surgery

The nurse is educating a pt who has been tx for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the teaching? A. Decreased the amount of fats in the diet. B. Increased the amount of potassium in the diet C. Decreased the amount of protein in the diet D. Increased the amount of magnesium in the diet

C. Decreased the amount of protein in the diet

What intervention does the nurse anticipate providing for the pt with ascites that will help correct the decreased in effective arterial blood volume that leads to sodium retention? A. Diuretic therapy B. Therapeutic paracentesis C. Platelet infusions D. Albumin infusion

D. Albumin infusion

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

D. Asterixis

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? A. Pain in the right upper quadrant radiating to the right shoulder B. Report of pain being worse when sitting upright C. Pain relieved with defecation D. Epigastric pain radiating to the left shoulder.

D. Epigastric pain radiating to the left shoulder.

A nurse on the medical surgical unit is admitting a client with Hep B with ascites. Which of the following actions should the nurse include in the plan of care? A. Initiate contact precautions. B. Weigh the client weekly C. Measure the abdominal girth 7.5 cm (3in) above the umbilicus D. Provide a high calorie high carbohydrate diet

D. Provide a high calorie high carbohydrate diet