Med Surg Chapter 25: Nursing Management: Patients With Hepatic and Biliary Disorders: PREPU

Which is a clinical manifestation of cholelithiasis? A. Clay-colored stools B. Abdominal pain in the upper left quadrant C. Epigastric distress before a meal D. Nonpalpable abdominal mass

A. The client with gallstones has clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder.

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. The nurse suspects that these findings result from: A. perforation of the colon caused by the liver biopsy. B. bleeding in the liver caused by the liver biopsy. C. normal postprocedural pain, with a change in the level of consciousness resulting from the preexisting fever. D. an allergic reaction to the contrast media used during the liver biopsy.

A This client exhibits classic signs and symptoms of a perforated colon — severe abdominal pain, fever, and a decreasing level of consciousness.

A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment? A. "The tube provides relief from nausea and vomiting." B. "The tube allows toxins to be removed." C. "The tube helps control fluid and electrolyte imbalance." D. "The tube allows the gastrointestinal tract to rest."

D.

Over the past 2 years, a 51-year-old man has been admitted to the hospital five times for problems related to alcohol abuse, including falls, acute alcohol withdrawal, and cirrhosis. The man's current admission has been precipitated by signs and symptoms of alcoholic liver disease (ALD). The care team is reasonably pleased with the patient's recovery to this point and discharge planning has begun. When organizing the patient's discharge planning, what psychosocial nursing diagnosis should be prioritized? A Risk for ineffective management of therapeutic regimen B. Risk for altered growth and development C. Risk for ineffective coping D. Risk for altered family processes

A.

The critical care nurse is caring for a patient with cirrhosis. What is a priority nursing function when caring for a patient with cirrhosis? A. Monitoring the patient's mental status B. Monitoring the patient's oral intake C. Monitoring the patient's social support network D. Monitoring the patient for signs of hypervolemia

A. The nurse monitors the patient's mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly.

A 59-year-old woman with a recent history of gallstones had a laparoscopic cholecystectomy performed this morning and has just been admitted to the postsurgical unit from the PACU. The nurse who will be providing this patient's immediate care should prioritize assessments that are related to what complication of a laparoscopic cholecystectomy? A. Hyperbilirubinemia B. Paralytic ileus C. Sepsis D. Bile duct injury

D.

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm his diagnosis? A. Presence of easy bruising and bradycardia B. Presence of blood in the client's stool and recent hypertension C. Adventitious breath sounds and hypertension D. Recent weight loss and temperature elevation

D.

Which position should be used for a client undergoing a paracentesis? A. Upright at the edge of the bed B. Supine C. Prone D. Trendelenburg

A

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

A

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply. A. fluid accumulation B. venous pressure C. fluid output D. blood coagulation

A, B

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply. A. Ecchymoses B. Aphthous stomatitis C. Cyanosis of the lips D. Petechiae E. Jaundice

A, D, E . The nurse observes the skin for Jaundice, petechiae or ecchymotic areas (bruises), spider angiomas, and palmar erythema. Cyanosis of the lips is indicative of a problem with respiratory or cardiovascular dysfunction. Aphthous stomatitis is a term for mouth ulcers and is a gastrointestinal abnormal finding

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? A. Pancreatitis B. Appendicitis C. Gastric ulcer D. Cholecystitis

A. Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis

The nurse reviews the laboratory values for a patient being evaluated for alcoholic cirrhosis. The nurse is aware that a diagnostic indicator present in greater than 70% of cases is which of the following? A. Alkaline phosphatase B. AST/ALT ratio >3.0 C. Albumin D. Total bilirubin

B

A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority? A. Excess fluid volume B. Ineffective breathing pattern C. Imbalanced nutrition: Less than body requirements D. Fatigue

B In ascites, accumulation of large amounts of fluid causes extreme abdominal distention, which may put pressure on the diaphragm and interfere with respiration. If uncorrected, this problem may lead to atelectasis or pneumonia. Although fluid volume excess is present, the diagnosis Ineffective breathing pattern takes precedence because it can lead more quickly to life-threatening consequences.

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? A. Oral bile acids B. Vitamin B C. Vitamin K D. Potassium

C

A patient has been admitted to the critical care unit from the subacute medical unit because his signs and symptoms of liver failure have become more pronounced over the past 24 hours. The critical care nurse who is planning this patient's care should prioritize which of the following nursing diagnoses? A. Knowledge deficit related to the causes of liver failure B. Risk for impaired gas exchange related to complications of liver failure C. Risk for bleeding related to complications of liver failure D. Bowel incontinence related to treatments for liver failure

C

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. instillation B. gavage C. decompression D. lavage

C

What is the recommended dietary treatment for a client with chronic cholecystitis? A. low-residue diet B. low-protein diet C. low-fat diet D high-fiber diet

C

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy? A. Negative Babinski reflex B. Increased motor activity C. Asterixis D. Irritability

C

A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver? A. Convert urea into ammonia B. Break down coagulation factors C. Breakdown amino acids D. Excrete bile

D. The liver forms and excretes bile, synthesizes amino acids from the breakdown of proteins, converts ammonia into urea, and synthesizes the factors needed for blood coagulation.

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired? A. Fat digestion B. Protein synthesis C. Carbohydrate digestion D. Protein digestion

C Amylase is a pancreatic enzyme involved in the breakdown and digestion of carbohydrates. Trypsin aids in the digestion of proteins. Lipase aids in the digestion of fats

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: A. Excess potassium loss subsequent to prolonged use of diuretics. B. Excessive diuresis and dehydration. C. Severe infections and high fevers. D. The digestion of dietary and blood proteins.

D. Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (ie, bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia.

A patient who had surgery for gallbladder disease has just returned to the unit. The nurse caring for this patient knows to immediately report what assessment finding to the primary care provider? A. Decreased breath sounds B. Acute pain with movement C. Drainage of "bile-colored fluid" onto the abdominal dressing D. Rigidity of the abdomen

D. Increased abdominal tenderness and rigidity (state of stiffness) should be reported immediately to the health care provider, as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure.