Liver, Pancreas, Gallbladder
A client who is recovering from hepatitis A has fatigue and malaise. The client asks the nurse, "When will my strength return?" Which response by the nurse is most appropriate? a) "It is normal for you to feel fatigued. The fatigue should go away in the next 2 to 4 months." b) "It is important for you to increase your activity level. That will help decrease your fatigue." c) "Your fatigue should be gone by now. We will evaluate you for a secondary infection." d) "Your fatigue is an adverse effect of your drug therapy. It will disappear when your treatment regimen is complete."
A) "It is normal for you to feel fatigued. The fatigue should go away in the next 2 to 4 months." Explanation: During the convalescent or posticteric stage of hepatitis, fatigue and malaise are the most common problems. These symptoms usually disappear within 2 to 4 months. Fatigue and malaise are not evidence of a secondary infection. Hepatitis A is not treated by drug therapy. It is important that the client continue to balance activity with periods of rest
A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a) Albumin b) Creatinine c) Chloride d) Urobilinogen
A) Albumin Explanation: Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.
A client who is scheduled for an open cholecystectomy has been smoking a pack of cigarettes a day for 20 years. For which postoperative complication is the client most at risk? a) atelectasis b) prolonged immobility c) delayed wound healing d) deep vein thrombosis
A) atelectasis Explanation: The client who has a significant cigarette smoking history and an operative manipulation close to the diaphragm (the gallbladder is against the liver) is at increased risk for atelectasis and pneumonia. Postoperatively, this client will be reluctant to deep breathe because of pain, in addition to having residual lung damage from smoking. Therefore, the client is at greater-than-average risk for pulmonary complications. The client does not have an increased risk of prolonged immobility (unless slowed by a respiratory problem), deep vein thrombosis (as long as the client performs leg exercises), or delayed wound healing (as long as the client maintains appropriate nutrition).
The nurse is completing a health history and physical assessment on a client admitted with esophageal varices and cirrhosis. What signs and symptoms alert the nurse to a potential internal hemorrhage? a) Pulse 80 bpm, temperature 99.1°F (37.3°C), pain in the right lower quadrant, and constipation b) Pulse 108 bpm, temperature 97.7°F (36.5°C), distended abdomen, and nausea c) Pulse 60 bpm, temperature 102.2°F (39°C), rebound tenderness in the right lower quadrant, and diarrhea d) Pulse 110 bpm, temperature 102.2°F (38.9°C), soft abdomen, and sounds in all four quadrants
B) Pulse 108 bpm, temperature 97.7°F (36.5°C), distended abdomen, and nausea Explanation: Increased pulse rate, a distended abdomen, and nausea signify the possibility of hemorrhage. The other choices are incorrect.
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) Providing mouth care b) Maintaining nothing-by-mouth (NPO) status c) Administering morphine I.V. as ordered d) Placing the client in a semi-Fowler's position
C) Administering morphine I.V. as ordered Explanation: 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
During the first few weeks after a cholecystectomy, the client should follow a diet that includes: a) a decreased intake of fruits, vegetables, whole grains, and nuts, to minimize pressure within the small intestine. b) at least four servings daily of meat, cheese, and peanut butter to increase protein intake that aids incisional healing. c) a limited intake of fat distributed throughout the day so there is not an excessive amount in the intestine at any one time. d) ingestion of pancreatic enzymes with meals to replace the normal enzyme secretion that has been surgically altered.
C) a limited intake of fat distributed throughout the day so there is not an excessive amount in the intestine at any one time. Explanation: Bile flows almost continuously into the intestine for the first few weeks after gallbladder removal. Limiting the amount of fat in the intestine at any one time ensures that adequate bile will be available to facilitate digestion. Eating large amounts of meat, cheese, and peanut butter would be undesirable because these foods are often high in fat.
A client presents with cirrhosis of the liver secondary to alcohol abuse. Which assessment findings would warrant immediate action by the nurse? a) Jugular vein distension b) Cramps and watery diarrhea c) Pulmonary edema d) Ascites and hematemesis
D) Ascites and hematemesis Explanation: As a result of a cirrhotic liver, there is an accumulation of fluid in the peritoneal cavity and hematemesis can present from esophageal varices that have ruptured into the stomach. Pulmonary edema is not associated with cirrhosis, but with left-sided heart failure. Jugular vein distension is present with right-sided heart failure. Cramps and diarrhea are usually not present.
