N406 Exam 2 PrepU Questions (BILIARY DISORDERS)

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? A. Hemolytic B. Hepatocellular C. Obstructive D. Nonobstructive

A. Hemolytic Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive and hepatocellular jaundice are results of liver disease. Nonobstructive jaundice occurs with hepatitis.

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. Constructional apraxia B. Fetor hepaticus C. Ataxia D. Asterixis

D. Asterixis Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy

A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis? A. A liver biopsy B. A CT scan C. A prothrombin time D. Platelet count

A. A liver biopsy A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure. It can be performed in the radiology department with ultrasound or CT to identify appropriate placement of the trocar or biopsy needle. A prothrombin time and platelet count will assist with determining if the client is at increased risk for bleeding.

Which of the following diagnostic studies definitely confirms the presence of ascites? A. Ultrasound of liver and abdomen B. Abdominal x-ray C. Colonoscopy D. Computed tomography of abdomen

A. Ultrasound of liver and abdomen Ultrasonography of the liver and abdomen will definitively confirm the presence of ascites. An abdominal x-ray, colonoscopy, and computed tomography of the abdomen would not confirm the presence of ascites.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: A. cannot tolerate high-glucose concentration. B. are at risk for gallbladder contraction. C. are at risk for hepatic encephalopathy. D. can digest high-fat foods.

A. cannot tolerate high-glucose concentration. Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

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. Dysfunction of the pancreatic islet cells B. Ingestion of foods high in sugar C. Inability for the liver to reabsorb serum glucose D. Renal failure

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

A. low-fat diet The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications.

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. Carbohydrate digestion B. Protein synthesis C. Fat digestion D. Protein digestion

A. Carbohydrate digestion 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.

A client with a lengthy history of alcohol addiction is being seen for jaundice. The appearance of jaundice would most likely indicate: A. liver disorder. B. gallbladder disease. C. bile overproduction. D. glucose underproduction.

A. liver disorder. Jaundice is a sign of disease, but it is not itself a unique disease. Jaundice accompanies many diseases that directly or indirectly affect the liver and is probably the most common sign of a liver disorder.

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

A. 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.

A nurse is gathering equipment and preparing to assist with a sterile bedside procedure to withdraw fluid from a client's abdomen. The procedure tray contains the following equipment: trocar, syringe, needles, and drainage tube. The client is placed in he high Fowler position and a blood pressure cuff is secured around the arm in preparation for which procedure? A. Liver biopsy B. Paracentesis C. Abdominal ultrasound D. Dialysis

B. Paracentesis Paracentesis is the removal of fluid (ascites) from the peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions. Paracentesis may be used to withdraw ascitic fluid if the accumulated fluid is causing cardiorespiratory compromise. A liver biopsy is removal of tissue from the liver using a scope or surgical instrument. An abdominal ultrasound is a non -invasive procedure using sound waves to produce images. Dialysis is the process of filtering blood as a substitute for normal kidney function.

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 requires more pain medication. B. The patient is developing a paralytic ileus. C. The patient has developed peritonitis. D. The patient has developed renal failure.

C. 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

A client has a tumor of the head of the pancreas. What clinical manifestations will the nurse assess? Select all that apply. A. Clay-colored stools B. Dark urine C. Jaundice D. Weight gain E. Persistent hiccups

A, B, C Sixty to eighty percent of pancreatic tumors occur in the head of the pancreas. Tumors in this region obstruct the common bile duct. The obstructed flow of bile produces jaundice, clay-colored stools, and dark urine. Malabsorption of nutrients and fat-soluble vitamins may result if the tumor obstructs the entry of bile to the gastrointestinal tract. Abdominal discomfort or pain and pruritus may be noted, along with anorexia, weight loss, and malaise. If these signs and symptoms are present, cancer of the head of the pancreas is suspected. Persistent hiccups are seen with stomach and bowel diseases.

A nurse admits a woman reporting severe right upper quadrant pain after eating dinner. What client risk factors lead the nurse to suspect gallbladder disease? Select all that apply. A. Multiparous B. Obese C. Older than 40 years old D. Smoking E. History of diabetes mellitus

A, B, C, E Two to three times more women than men develop cholesterol stones and gallbladder disease; affected women are usually older than 40 years, multiparous, and obese. Diabetes mellitus, cystic fibrosis and frequent weight changes predispose a client to gallbladder disease. Smoking is not a related factor.

The nurse is caring for a client experiencing pain related to chronic pancreatitis. When developing a care plan for alternative strategies to opoid usage, which approaches will the nurse include? Select all that apply. A. Vitamin E B. Amitriptyline C. Tetracycline D. Methylprednisolone E. Ibuprofen

A, B, E In chronic pancreatitis, management of abdominal pain and discomfort is similar to that of acute pancreatitis; however, the focus is usually on the use of nonopioid methods to manage pain. Adjunct means of pain modulation include the use of antioxidants such as Vitamin E, antidepressants such as amitriptyline, avoiding alcohol, smoking cessation, and the use of nonopioid analgesics like ibuprofen. Tetracycline is an antibiotic and has been implicated as a caustive agent of acute pancreatitis. Methylprednisolone is a steroid and may induce acute pancreatitis in some clients.

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. Acute pain related to biliary spasms B. Deficient knowledge related to prevention of disease recurrence C. Anxiety related to unknown outcome of hospitalization D. Imbalanced nutrition: Less than body requirements related to biliary inflammation

A. 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.

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. Frequent vomiting, leading to loss of fluid volume B. Dry mouth, which makes the client thirsty C. Acetone in the urine D. High glucose concentration in the blood

A. 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 and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations? A. Hepatic encephalopathy B. Esophageal varices C. Hepatitis C D. Portal hypertension

A. Hepatic encephalopathy The earliest symptoms of hepatic encephalopathy include minor mental changes and motor disturbances. The client appears slightly confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and have restlessness and insomnia at night. As hepatic encephalopathy progresses, the client may become difficult to awaken and completely disoriented with respect to time and place. With further progression, the client lapses into frank coma and may have seizures. Simple tasks, such as handwriting, become difficult.

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. Hot roast beef sandwich with gravy B. Mashed potatoes C. White rice D. Vanilla pudding

A. 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 roast beef because fatty foods may bring on an episode of cholecystitis.

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 gallbladder and bile duct. B. It visualizes the liver and pancreas. C. It shows the sizes of the abdominal organs and detects any masses. D. It visualizes the biliary structures and pancreas via endoscopy.

A. 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.

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

A. 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.

The nurse identifies a potential collaborative problem of electrolyte imbalance for a client with severe acute pancreatitis. Which assessment finding alerts the nurse to an electrolyte imbalance associated with acute pancreatitis? A. Muscle twitching and finger numbness B. Paralytic ileus and abdominal distention C. Hypotension D. Elevated blood glucose concentration

A. Muscle twitching and finger numbness Muscle twitching and finger numbness indicate hypocalcemia, a potential complication of acute pancreatitis. Calcium may be prescribed to prevent or treat tetany, which may result from calcium losses into retroperitoneal (peripancreatic) exudate. The other data indicate other complications of acute pancreatitis but are not indicators of electrolyte imbalance.

A client is actively bleeding from esophageal varices. Which medication would the nurse MOST expect to be administered to this client? A. Octreotide B. Spironolactone C. Propranolol D. Lactulose

A. Octreotide In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Octreotide (Sandostatin) causes selective splanchnic vasoconstriction by inhibiting glucagon release and is used mainly in the management of active hemorrhage. Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in clients with known varices and to prevent rebleeding. Beta-blockers should not be used in acute variceal hemorrhage, but they are effective prophylaxis against such an episode. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Lactulose (Cephulac) is administered to reduce serum ammonia levels in clients with hepatic encephalopathy.

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 the diagnosis of acute pancreatitis? A. Pain with abdominal distention and hypotension B. Presence of blood in the client's stool and recent hypertension C. Presence of easy bruising and bradycardia D. Adventitious breath sounds and hypertension

A. Pain with abdominal distention and hypotension Assessment findings associated with pancreatitis include pain with abdominal distention and hypotension. Blood in stools and recent hypertension aren't associated with pancreatitis; fatty diarrhea and hypotension are usually present. Presence of easy bruising and bradycardia aren't found with pancreatitis; the client typically experiences tachycardia, not bradycardia. Adventitious breath sounds and hypertension aren't associated with pancreatitis.

The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis? A. Pancreatitis can elevate the diaphragm and alter the breathing pattern. B. Pancreatitis causes thickening of pulmonary secretions, impairing oxygenation. C. Pancreatitis can atrophy the diaphragm and alter the breathing pattern. D. Pancreatitis causes alterations to hemoglobin, impairing oxygenation.

A. Pancreatitis can elevate the diaphragm and alter the breathing pattern. Aggressive pulmonary care is required for clients with acute pancreatitis. Pancreatitis can elevate the diaphragm and alter the breathing pattern of clients. Pancreatitis can cause retention of pulmonary secretions but does not thicken the secretions. Acute pancreatitis does not alter the hemoglobin.

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. Relieving abdominal pain B. Preventing fluid volume overload C. Maintaining adequate nutritional status D. Teaching about the disease and its treatment

A. 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.

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. Urinary output related to increased sodium retention C. Peripheral vascular assessment related to immobility D. Skin assessment related to increase in bile salts

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.

A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? A. Tetany related to hypocalcemia B. Muscle spasm related to hypokalemia C. Muscle pain related to referred pain manifestations D. Tetany related to hypercalcemia

A. Tetany related to hypocalcemia A client with acute pancreatitis who reports muscle cramping or pain should be suspected of having hypocalcemia and tetany of the muscles. Hypocalcemia may occur in acute pancreatitis because, when auto digestion of the pancreas occurs, calcium binds to fatty acids and calcium is decreased in the blood. This is a potentially life-threatening complication of pancreatitis and needs to be immediately addressed.

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's hepatic function is decreasing. B. The client didn't take his morning dose of lactulose (Cephulac). C. The client is relaxed and not in pain. D. The client is avoiding the nurse.

A. 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.

Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses? A. Ultrasonography B. Magnetic resonance imaging C. Angiography D. Electroencephalogram

A. Ultrasonography A ultrasonography will show the size of the abdominal organs and the presence of masses. Magnetic resonance imaging is used to detect hepatic neoplasms. An angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. An electroencephalogram is used to detect abnormalities that occur with hepatic coma.

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis? A. Weight loss B. Diarrhea C. Fatigue D. Hypertension

A. Weight loss Weight loss is most common in the client with chronic pancreatitis due to decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack. The other answer choices are not the most common complications related to chronic pancreatitis.

A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is most appropriate for a client with this diagnosis? A. Withholding all oral intake, as ordered, to decrease pancreatic secretions B. Administering meperidine, as ordered, to relieve severe pain C. Limiting I.V. fluids, as ordered, to decrease cardiac workload D. Keeping the client supine to increase comfort

A. Withholding all oral intake, as ordered, to decrease pancreatic secretions The nurse should withhold all oral intake to suppress pancreatic secretions, which may worsen pancreatitis. Pain relief may require parenteral opioids such as morphine, fentanyl (Sublimaze), or hydromorphone (Dilaudid). No clinical evidence supports the use of meperidine for pain relief in pancreatitis, and, in fact, accumulation of its metabolites can cause CNS irritability and possibly seizures. Pancreatitis places the client at risk for fluid volume deficit from fluid loss caused by increased capillary permeability. Therefore, this client needs fluid resuscitation, not fluid restriction. A client with pancreatitis is most comfortable lying on the side with knees flexed.

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. decompression B. instillation C. gavage D. lavage

A. 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 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 2 weeks and the third in 1 month." B. "You must have the second one in 1 month and the third in 6 months." C. "You must have the second one in 6 months 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 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 should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of: A. Serum calcium B. Serum lipase C. Serum bilirubin D. Serum amylase

B. Serum lipase Serum amylase and lipase levels are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but serum lipase levels may remain elevated days longer than amylase.

A patient 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 patient expresses thirst D. For 6 hours after the procedure

B. Until the gag reflex returns After the endoscopic examination, fluids are not given until the patient's gag reflex returns.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? A. Spironolactone B. Vasopressin C. Nitroglycerin D. Cimetidine

B. Vasopressin Vasopressin may be the initial therapy for esophageal varices because it produces constriction of the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.

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. Potassium B. Vitamin K C. Vitamin B D. Oral bile acids

B. Vitamin K Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: A. severe abdominal pain radiating to the shoulder. B. anorexia, nausea, and vomiting. C. eructation and constipation. D. abdominal ascites.

B. anorexia, nausea, and vomiting. Early hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.

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 calcium B. Serum bilirubin C. Serum amylase D. Serum potassium

C. 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.

A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client? A. Furosemide B. Acetazolamide C. Spironolactone D. Ammonium chloride

C. Spironolactone The use of diuretic agents along with sodium restriction is successful in 90% of clients with ascites. Spironolactone, an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. When used with other diuretic agents, spironolactone helps prevent potassium loss. Oral diuretic agents such as furosemide may be added but should be used cautiously because long-term use may induce severe hyponatremia (sodium depletion). Acetazolamide and ammonium chloride are contraindicated because of the possibility of precipitating hepatic encephalopathy and coma.

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? A. Jaundice B. Pruritus of the arms and legs C. Fatigue during ambulation D. Irritability and drowsiness

D. Irritability and drowsiness Although all the options are associated with hepatitis B, the onset of irritability and drowsiness suggests a decrease in hepatic function. To detect signs and symptoms of disease progression, the nurse should observe for disorientation, behavioral changes, and a decreasing level of consciousness and should monitor the results of liver function tests, including the blood ammonia level. If hepatic function is decreased, the nurse should take safety precautions.

Is the following statement true or false?Bleeding esophageal varices results in an increase in renal perfusion.

False

A patient admitted with severe epigastric abdominal pain radiating to the back is vomiting and complaining of difficulty breathing. Upon assessment, the nurse determines that the patient is experiencing tachycardia and hypotension. Which of the following actions is a priority intervention for this patient? Select all that apply: 1.Administer pain-relieving medication 2.Administer a low-fat diet. 3.Administer electrolytes 4.Administer plasma. 5. Assist the patient to a semi-Fowler's position

1, 3, 4, 5

A patient who had a recent myocardial infarction was brought to the emergency department 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? 1. Vasopressin (Pitressin) 2. Epinephrine 3. Octreotide (Sandostatin) 4. Glucagon

3.

In the pancreas, the acinar cells release: A. Amylase B. Somatostatin C. Lipase D. Protease

A, C, D

While assisting a patient with chronic pancreatitis to the bathroom, you note the patient's stool to be oily/greasy in appearance. In your documentation you note this as: A. Steatorrhea B. Melena C. Currant D. Hematochezia

A.Steatorrhea is an oily/greasy appearance of the stool which can occur in chronic pancreatitis. This occurs due to the inability of the pancreas to produce digestive enzymes which help break down fats. Fats are not being broken down; therefore, it is being excreted into the stool. Melena is used to describe tarry/black stool, hematochezia is used to describe red stools, and currant are jelly type stools.

Your patient with acute pancreatitis is scheduled for a test that will use a scope to assess the pancreas, bile ducts, and gallbladder. The patient asks you, "What is the name of the test I'm going for later today?" You tell the patient it is called: A. MRCP B. ERCP C. CT scan of the abdomen D. EGD

B

When caring for a client with acute pancreatitis, the nurse should use which comfort measure? A. Administering an analgesic once per shift, as ordered, to prevent drug addiction B. Positioning the client on the side with the knees flexed C. Encouraging frequent visits from family and friends D. Administering frequent oral feedings

B. Positioning the client on the side with the knees flexed The nurse should place the client with acute pancreatitis in a side-lying position with knees flexed; this position promotes comfort by decreasing pressure on the abdominal muscles. The nurse should administer an analgesic, as needed and ordered, before pain becomes severe, rather than once each shift. Because the client needs a quiet, restful environment during the acute disease stage, the nurse should discourage frequent visits from family and friends. Frequent oral feedings are contraindicated during the acute stage to allow the pancreas to rest.

A patient is admitted to the ER with the following signs and symptoms: very painful mid-epigastric pain felt in the back, elevated glucose, fever, and vomiting. During the head-to-toe assessment, you notice bluish discoloration around the belly button. As the nurse, you know this is called: A. Grey-Turner's Sign B. McBurney's Sign C. Homan's Sign D. Cullen's Sign

D

During a home health visit, you are assessing how a patient takes the prescribed pancreatic enzyme. The patient is unable to swallow the capsule whole, so they open the capsule and mix the beads inside the capsule with food/drink. Which food or drink is safe for the patient to mix the beads with? A. Pudding B. Ice cream C. Milk D. Applesauce

D

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

D. 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 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. blood coagulation D. fluid output

A, B Methods of treating portal hypertension aim to reduce venous pressure and fluid accumulation.

What is a major symptom of chronic pancreatitis? A.Recurrent attacks of severe upper abdominal and back pain accompanied by vomiting B.Fever, jaundice, confusion, and agitation C.Ecchymosis in the flank or umbilical area D.Abdominal guarding

A.

A client who is 24 hours post op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms? A. "Apply a heating pad to your shoulder for 15 minutes hourly as needed." B. "Come into the emergency room as soon as possible." C. "Take an over the counter analgesic as needed." D. "Place your shoulder in a sling to avoid moving it."

A. "Apply a heating pad to your shoulder for 15 minutes hourly as needed." Pain in the right shoulder may occur after laparoscopic cholecystectomy due to migration of the carbon dioxide used to insufflate the abdominal cavity during the procedure. The nurse should instruct the client to apply a heating pad to the shoulder for 15 to 20 minutes every hour as needed for pain relief. The nurse should not instruct the client to take analgesic medication-this is a medical order performed by the health care provider only. This scenario is not life threatening and the client does not need to go to the emergency department. It is also not necessary for the client to place the shoulder in a sling as this is not an injury-related condition.

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 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." C. "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." 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.

Gynecomastia is a common side effect of which of the following diuretics? A. Spironolactone B. Furosemide C. Vasopressin D. Nitroglycerin (IV)

A. Spironolactone Gynecomastia is a common side effect caused by spironolactone. Vasopressin is used for bleeding esophageal varices and is not a diuretic. Nitroglycerin (IV) may be used with vasopressin to counteract the effects of vasoconstriction from the vasopressin.

A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? A. Temperature B. Albumin C. Hemoglobin D. Bilirubin

B. Albumin With the movement of albumin from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure, results in movement of fluid into the peritoneal cavity. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of ascites and edema.

Which foods should be avoided following acute gallbladder inflammation? A. Cooked fruits B. Cheese C. Coffee D. Mashed potatoes

B. Cheese The client should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the client that fatty foods may induce an episode of cholecystitis. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non-gas-forming vegetables, bread, coffee, or tea may be consumed as tolerated.

A client with calculi in the gallbladder is said to have: A. Cholecystitis B. Cholelithiasis C. Choledocholithiasis D. Choledochotomy

B. Cholelithiasis Calculi, or gallstones, usually form in the gallbladder from the solid constituents of bile; they vary greatly in size, shape, and composition. Cholecystitis is acute inflammation of the gallbladder. Choledocholithiasis is a gallstone in the common bile duct. Choledochotomy is an incision into the common bile duct.

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority? A. Disturbed body image B. Impaired nutrition: less than body requirements C. Nausea D. Anxiety

B. Impaired nutrition: less than body requirements While each diagnosis may be applicable to this client, the priority nursing diagnosis is impaired nutrition: less than body requirements. The physician, nurse, and dietitian emphasize to the client and family the importance of avoiding alcohol and foods that have produced abdominal pain and discomfort in the past. Oral food or fluid intake is not permitted during the acute phase.

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. Loss of 2.2 lb (1 kg) in 24 hours C. Serum sodium level of 135 mEq/L D. Blood pH of 7.25

B. 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 nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority? A. Developing no acute complications from the pancreatitis B. Maintaining normal respiratory function C. Maintaining satisfactory pain control D. Achieving adequate fluid and electrolyte balance

B. Maintaining normal respiratory function Airway and breathing are always the priority assessment. Acute pancreatitis produces retroperitoneal edema, elevation of the diaphragm, pleural effusion, and inadequate lung ventilation. Intra-abdominal infection and labored breathing increase the body's metabolic demands, which further decreases pulmonary reserve and can lead to respiratory failure. Maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

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. Report the condition to the physician immediately. B. Measure abdominal girth according to a set routine. C. Provide the client with nonprescription laxatives. D. Ask the client about food intake.

B. 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.

Which is the most common cause of esophageal varices? A. Jaundice B. Portal hypertension C. Ascites D. Asterixis

B. Portal hypertension Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

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. Placing the client in a semi-Fowler's position B. Maintaining nothing-by-mouth (NPO) status C. Administering morphine I.V. as ordered D. Providing mouth care

C. 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.

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? A. Straw-colored urine B. Reduced hematocrit C. Clay-colored stools D. Elevated urobilinogen in the urine

C. Clay-colored stools Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

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

C. 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.

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. Spironolactone B. Cholestyramine C. Lactulose D. Kanamycin

C. 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.

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

C. 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.

The nurse instructs a client on care at home after a laparoscopic cholecystectomy. Which client statement indicates that teaching has been effective? A. "I can drive after 2 weeks." B. "I can take a shower in a week." C. "I should remain on bed rest for several days." D. "I should wash the site with mild soap and water."

D. "I should wash the site with mild soap and water." After a laparoscopic cholecystectomy, the client should be instructed about pain management, activity and exercise, wound care, nutrition, and follow-up care. The client should be directed to wash the puncture site with mild soap and water when caring for the wound. When resuming activity, the client should be instructed to drive after 3 or 4 days, take a shower or bath after 1 or 2 days, and begin light exercise such as walking immediately.

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. Creatinine B. Urobilinogen C. Chloride D. Albumin

D. Albumin 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.

When caring for a client with cirrhosis, which symptoms should a nurse report immediately? Select all that apply. A. change in mental status B. signs of GI bleeding C. anorexia and dyspepsia D. diarrhea or constipation

A, B The nurse reports any change in mental status or signs of GI bleeding immediately because they indicate secondary complications.

A nurse in the surgical ICU just received a client from recovery following a Whipple procedure. Which nursing diagnoses should the nurse consider when caring for this acutely ill client? Select all that apply. A. potential for infection B. acute pain and discomfort C. alterations in respiratory function D. fluid volume excess

A, B, C Monitor for potential for infection related to invasive procedure and poor physical condition. Monitor for pain related to extensive surgical incision. Monitor for alterations in respiratory function related to extensive surgical incisions, immobility, and prolonged anesthesia. Client is at risk for fluid volume deficit related to hemorrhage and loss of fluids.

Which condition indicates an overdose of lactulose? A. Watery diarrhea B. Constipation C. Hypoactive bowel sounds D. Fecal impaction

A. Watery diarrhea The client receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.

The nurse is assessing a client admitted with suspected pancreatitis. Which question will the nurse prioritize when assessing this client? A. "How many meals do you eat every day?" B. "How much alcohol do you consume in a day?" C. "When was the last time you took acetaminophen?" D. "How often and how long do you exercise each day?

B. "How much alcohol do you consume in a day?" Chronic pancreatitis is an inflammatory disorder characterized by progressive destruction of the pancreas. Alcohol consumption in Western societies is the major cause of chronic pancreatitis. Excessive and prolonged consumption of alcohol accounts for approximately 70% to 80% of all cases of chronic pancreatitis. The incidence of pancreatitis is 50 times greater in people with alcoholism than in those who do not abuse alcohol. The type of food (like fried or heavily processed foods) rather than the number of meals eaten each day may contribute to pancreatitis and subsequent flare-ups of the condition. The prescibed use of acetaminophen is not a typical risk factor in pancreatitis and is rare with cases of overdose. The amount and/or lack of exercise is not directly linked to pancreatitis. Risk factors do include obesity.

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? A. Shock B. Pancreatic necrosis C. MODS D. Tetany

B. Pancreatic necrosis Pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Shock and multiple organ failure may occur with acute pancreatitis. Tetany is not a major cause of morbidity and mortality in clients with acute pancreatitis.

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? A. Appendicitis B. Pancreatitis C. Cholecystitis D. Peptic ulcer

B. Pancreatitis Hypotension is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. The other conditions are less likely to exhibit fluid volume deficit.

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

B. 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.

Inside the pancreas are special cells that secrete digestive enzymes and hormones. The cells that secrete digestive enzymes are known as ______________ cells. A. Islet of Langerhans B. Protease C. Acinar D. Amylase

C

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. Duodenum C. Gallbladder D. Common bile duct

C. Gallbladder The gallbladder functions as a storage depot for bile.

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 decrease metabolism B. To depress the central nervous system and increase the pain threshold C. To reduce gastric and pancreatic secretions D. To relieve nausea and vomiting

C. To reduce gastric and pancreatic secretions Anticholinergic medications reduce gastric and pancreatic secretion.