Week 11 cirrhosis

Question 10 of 14 A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? A. High fat B. High fiber C. Carbohydrates D. Protein

✅ANS: D Protein The nurse tells the client not to mix enzyme preparations with foods containing protein because the enzymes will dissolve the food into a watery substance. Pancreatic-enzyme replacement therapy (PERT) is the standard of care to prevent malnutrition, malabsorption, and excessive weight loss. Pancrelipase is usually prescribed in capsule or tablet form and contains varying amounts of amylase, lipase, and protease. No evidence suggests that enzyme preparations should not be mixed with carbohydrates, food with highfat content, and food with high-fiber content.

1. The patient has a diagnosis of a biliary obstruction from gallstones. What type of jaundice is the patient experiencing, and what serum bilirubin results would be expected? a. Hemolytic jaundice with normal conjugated bilirubin b. Posthepatic icterus with decreased unconjugated bilirubin c. Obstructive jaundice with increased unconjugated and conjugated bilirubin d. Hepatocellular jaundice with decreased conjugated bilirubin in severe

1. c. Gallstones cause obstructive or posticteric jaundice and may increase both conjugated and unconjugated bilirubin.

12. Following a needle stick, what is used as prophylaxis against HBV? a. Interferon b. HBV vaccine c. Hepatitis B immune globulin (HBIG) d. HBIG and HBV vaccine

d. HBV vaccine and hepatitis B immune globulin (HBIG) are used together prophylactically after a needle stick. Interferon is used to treat chronic HBV.

Extracorporeal Shock Wave Lithotripsy (ESWL)

THERAPEUTIC PROCEDURES Shock waves are used to break up stones. This can be used more on nonsurgical candidates of normal weight who have small, cholesterol-based stones. NURSING ACTIONS ● Instruct and assist the client to lay on a fluid-filled pad for delivery of shock waves. ● Administer analgesia. CLIENT EDUCATION: Several procedures can be required to break up all stones. There can be pain intraprocedure due to gallbladder spasms or movement of the stones. CH 53 CHOLECYSTITIS AND CHOLELITHIASIS

21. Patient-Centered Care: A patient was diagnosed with nonalcoholic fatty liver disease (NAFLD). What treatment measures should the nurse plan to teach the patient about (select all that apply)? a. Weight loss b. Diabetes management c. Ulcerative colitis dietary changes d. Dietary management of hyperlipidemia e. Maintaining blood pressure with increased sodium and fluid intake

a, b, d. There is no treatment for nonalcoholic fatty liver disease (NAFLD) except to control the other diseases that are common in these persons. These measures include weight loss for obesity, control of blood glucose for diabetes, control of hyperlipidemia, and treating hypertension if it is present. Ulcerative colitis is unrelated to NAFLD.

41. A patient with acute pancreatitis has a nursing diagnosis of acute pain resulting from distension of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in this patient's plan of care? a. Provide diversional activities to distract the patient from the pain. b. Provide small, frequent meals to increase the patient's tolerance to food. c. Position the patient on the side with the head of the bed elevated 45 degrees for pain relief. d. Ambulate the patient every 3 to 4 hours to increase circulation and decrease abdominal congestion.

c. Positions that flex the trunk and draw the knees up to the abdomen help relieve the pain of acute pancreatitis. Positioning the patient on the side with the head elevated decreases abdominal tension. Diversional techniques are not as helpful as positioning in controlling the pain. The patient is usually NPO because food intake increases the pain and inflammation. Bed rest is indicated during the acute attack because of hypovolemia and pain.

36. A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse? a. "If you are interested in a transplant, you really should talk to your doctor about it." b. "Liver transplants are indicated only in young people with irreversible liver disease." c. "Rejection is such a problem in liver transplants that it is seldom attempted in patients with cirrhosis." d. "Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?"

d. Liver transplantation is indicated for patients with cirrhosis as well as for many adults and children with other irreversible liver diseases. Liver transplantation is contraindicated with severe extrahepatic disease, cancers, ongoing drug or alcohol use, and inability to comprehend or comply with the rigorous posttransplant care. Nurses should be knowledgeable about the indications for transplantation and be able to discuss the patient's questions and concerns related to transplantation. Rejection is less of a problem in liver transplants than with other organs, such as the kidney.

20. The patient is an older woman with cirrhosis who has anemia. What pathophysiologic changes may contribute to this patient's anemia (select all that apply)? a. Vitamin B deficiencies b. Stretching of liver capsule c. Vascular congestion of spleen d. Decreased prothrombin production e. Decreased bilirubin conjugation and excretion

a, c, d. The anemia of cirrhosis is related to overactivity of the enlarged spleen that removes blood cells from circulation. Vitamin B deficiencies from altered intake and metabolism of nutrients and decreased prothrombin production can increase bleeding tendencies. The other options do not contribute to anemia in the patient with cirrhosis

3. The patient returned from a 6-week mission trip to Somalia with reports of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted? a. Hepatitis B (HBV) b. Hepatitis C (HCV) c. Hepatitis D (HDV) d. Hepatitis E (HEV)

3. d. Hepatitis E virus (HEV) is associated with poor sanitation and contaminated water in developing countries.

47. Which characteristics are most commonly associated with cholelithiasis (select all that apply). a. Obesity b. Age over 40 years c. Multiparous female d. History of excessive alcohol intake e. Family history of gallbladder disease f. Use of estrogen or oral contraceptives

a, b, c, e, f. Incidence of cholelithiasis is higher in women, multiparous women, persons over 40 years of age, and those with family history and obesity. Postmenopausal women taking estrogen replacement therapy and younger women on oral contraceptives have a higher incidence. Alcohol intake and diet do not increase the incidence of cholelithiasis.

44. The nurse is teaching a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (select all that apply)? a. Avoid nicotine. b. Eat bland foods. c. Observe stools for steatorrhea. d. Eat high-fat, low-protein, high-carbohydrate meals. e. Take prescribed pancreatic enzymes immediately after meals.

a, b, c. Measures to prevent attacks of pancreatitis are those that decrease the stimulation of the pancreas. Lower fat intake and foods that are less stimulating and irritating (bland) should be encouraged. High carbohydrates are less stimulating. Avoid alcohol and nicotine, since both stimulate the pancreas. Monitor for steatorrhea to determine the effectiveness of the enzymes and because it may indicate worsening pancreatic function. Pancreatic enzymes should be taken with, not after, meals.

48. Acalculous cholecystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this condition (select all that apply)? a. Fasting b. Hypothyroidism c. Parenteral nutrition d. Prolonged immobility e. Streptococcus pneumoniae f. Absence of bile in the intestine

a, c, d. Acalculous cholecystitis is associated with prolonged immobility, fasting, prolonged parenteral nutrition, and diabetes. Hypothyroidism, Streptococcus pneumoniae, and absence of bile in the intestine are unrelated to this condition.

46. In a radical pancreaticoduodenectomy (Whipple procedure) for treatment of cancer of the pancreas, what resection most affects the patient's nutritional status? a. Duodenum b. Part of the stomach c. Head of the pancreas d. Common bile duct and gall bladder

a. In a Whipple procedure, the head of the pancreas, the duodenum which is next to the pancreas, distal segment of the common bile duct, the gall bladder, and the distal portion of the stomach are removed. The duodenum is responsible for the breakdown of food in the small intestine and regulates the rate of stomach emptying, which affects the patient's nutritional status.

51. What treatment for acute cholecystitis will prevent further stimulation of the gallbladder? a. NPO with NG suction b. Incisional cholecystectomy c. Administration of antiemetics d. Administration of anticholinergics

a. NPO and nasogastric (NG) suction prevent gallbladder stimulation from food or fluids moving into the duodenum. Laparoscopic cholecystectomy is used more often than incisional cholecystectomy, but both remove the gallbladder, not its stimulation. Administration of antiemetics decreases nausea and vomiting but does not decrease gallbladder stimulation. Anticholinergics counteract the smooth muscle spasms of the bile ducts to decrease pain.

54. What must the nurse do to care for a T-tube in a patient after a cholecystectomy? a. Keep the tube supported and free of kinks. b. Attach the tube to low, continuous suction. c. Clamp the tube when ambulating the patient. d. Irrigate the tube with 10-mL sterile saline every 2 to 4 hours.

a. The T-tube drains bile from the common bile duct until swelling from trauma has subsided, and bile can freely enter the duodenum. The tube is placed to gravity drainage and should be kept open and free from kinks to prevent bile from backing up into the liver. The tube is not normally clamped or irrigated.

50. The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse teach the patient about this test? a. It is noninvasive and is a very reliable method of detecting gallstones. b. It is the only test to use when the patient is allergic to contrast medium. c. It will outline the gallbladder and the ductal system to enable visualization of stones. d. It is an adjunct to liver function tests to determine whether the gallbladder is inflamed.

a. Ultrasonography is accurate in detecting gallstones and is a noninvasive procedure. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) may also be used when the patient is allergic to contrast medium. An IV cholangiogram uses radiopaque dye to outline the gallbladder and ducts. Liver function studies will be increased if liver damage has occurred but do not indicate gallbladder disease.

26. The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply) a. gastrointestinal (GI) bleeding. b. hypokalemia. c. renal function. d. body image disturbances. e. increased clotting tendencies.

b, c. With diuretic therapy, fluid and electrolyte balance must be monitored; serum levels of sodium, potassium, chloride, and bicarbonate must be monitored, especially for hypokalemia. Renal function must be monitored with blood urea nitrogen and serum creatinine. Water excess is manifested by muscle cramping, weakness, lethargy, and confusion. Gastrointestinal (GI) bleeding, body image disturbances, and bleeding tendencies seen with cirrhosis are not related to diuretic therapy.

49. A patient with an obstruction of the common bile duct has clay-colored fatty stools among other manifestations. What is the pathophysiologic change that causes this manifestation? a. Water-soluble (conjugated) bilirubin in the blood excreted into the urine b. Absence of bilirubin and bile salts in the small intestine prevents conversion to urobilinogen and fat emulsion and digestion c. Contraction of the inflamed gallbladder and obstructed ducts stimulated by cholecystokinin when fats enter the duodenum d. Obstruction of the common duct prevents bile drainage into the duodenum, resulting in congestion of bile in the liver and subsequent absorption into the blood

b. Absence of bilirubin and bile salts in the intestine lead to clay- colored stools and steatorrhea. Soluble bilirubin in the blood excreted into the urine leads to dark urine. Contraction of the inflamed gallbladder leads to pain with fatty food intake. Obstruction of the common bile duct prevents bile drainage into the duodenum, with congestion of bile in the liver. Bilirubin absorption in the blood leads to jaundice.

39. Combined with clinical manifestations, what is the laboratory finding that is most commonly used to diagnose acute pancreatitis? a. Increased serum calcium b. Increased serum amylase c. Increased urinary amylase d. Decreased serum glucose

b. Although serum lipase levels and urinary amylase levels are increased, an increased serum amylase level is the criterion most commonly used to diagnose acute pancreatitis in the first 24 to 72 hours. Serum calcium levels are decreased and serum glucose is increased.

10. During the incubation period of viral hepatitis, what should the nurse expect the patient to report? a. Dark urine and easy fatigability b. No symptoms except diagnostic results c. Anorexia and right upper quadrant discomfort d. Constipation or diarrhea with light-colored stools

b. During the incubation period, there are no symptoms, but serologic and enzyme markers of the disease are present. Earliest symptoms may include anorexia and discomfort in the upper right quadrant of the abdomen. Pruritus, dark urine, and light-colored stools occur with the onset of jaundice in the acute phase. Easy fatigability and malaise are seen in the convalescent phase as jaundice disappears.

45. What is a risk factor associated with pancreatic cancer? a. Alcohol intake b. Cigarette smoking c. Exposure to asbestos d. Increased dietary intake of spoiled milk products

b. Major risk factors for pancreatic cancer are cigarette smoking, chronic pancreatitis, diabetes, age, family history of pancreatic cancer, high-fat diet, and exposure to benzidine. Pancreatic cancer is not directly associated with alcohol intake, as pancreatitis is.

13. The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. What is the best response by the nurse? a. "No immunization is available for hepatitis A, nor are you likely to get the disease." b. "Those who have had household or close contact with the patient should receive IG." c. "All family members should receive the hepatitis A vaccine to prevent or modify the infection." d. "Only those people who have had sexual contact with the patient should receive immunization."

b. People who have been exposed to hepatitis A through household contact or foodborne outbreaks should be given IG within 1 to 2 weeks of exposure to prevent or modify the illness. Hepatitis A vaccine is used to provide preexposure immunity to the virus. Although hepatitis A may be spread by sexual contact, the risk is higher for transmission with the oral- fecal route.

34. In discussing long-term management with the newly diagnosed patient with alcoholic cirrhosis, what should the nurse teach the patient? a. A daily exercise regimen is important to increase the blood flow through the liver. b. Cirrhosis can be reversed if the patient follows a regimen of proper rest and nutrition. c. Abstinence from alcohol is the most important factor in improvement of the patient's condition. d. The only over-the-counter analgesic that should be used for minor aches and pains is acetaminophen.

c. Abstinence from alcohol is very important in alcoholic cirrhosis and may result in improvement if started when liver damage is limited. Although further liver damage may be reduced by rest and nutrition, most changes in the liver cannot be reversed. Exercise does not promote portal circulation, and very moderate exercise is recommended. Acetaminophen should not be used by the patient with alcoholic cirrhosis because this liver is more sensitive to the hepatotoxicity of acetaminophen.

53. A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse? a. "A low-fat diet will prevent the development of further gallstones and should be continued." b. "Yes; because you will not have a gallbladder to store bile, you will not be able to digest fats adequately." c. "A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile." d. "Removing the gallbladder will eliminate the source of your pain that was associated with fat intake, so you may eat whatever you like."

c. After removal of the gallbladder, bile drains directly from the liver into the duodenum and a low-fat diet is recommended until adjustment to this change occurs. Most patients tolerate a regular diet with moderate fat intake but should avoid excessive fat intake, as large volumes of bile previously stored in the gallbladder are not available. Steatorrhea could occur with a large fat intake.

55. During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in the teaching? a. Keep the incision area clean and dry for at least a week. b. Report the need to take pain medication for shoulder pain. c. Report any bile-colored or purulent drainage from the incisions. d. Expect some postoperative nausea and vomiting for several days.

c. Bile-colored drainage or pus from any incision may indicate an infection and should be reported to the HCP immediately. The bandages on the puncture sites should be removed the day after surgery, followed by showering. Referred shoulder pain is a common and expected problem following laparoscopic procedures, when carbon dioxide used to inflate the abdominal cavity is not readily absorbed by the body. Nausea and vomiting are not expected postoperatively and may indicate damage to other abdominal organs and should be reported to the HCP.

52. After a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care? a. Return to work in 2 to 3 weeks b. Be hospitalized for 3 to 5 days postoperatively c. Have a T-tube placed in the common bile duct to provide bile drainage d. Have up to 4 small abdominal incisions covered with small dressings

d. The laparoscopic cholecystectomy requires 1 to 4 small abdominal incisions to visualize and remove the gallbladder, and the patient has small dressings placed over these incisions. The patient with an incisional cholecystectomy is usually hospitalized for 2 to 3 days, whereas the laparoscopic procedure allows same-day or next-day discharge with return to work within 1 week. A T-tube is placed in the common bile duct after exploration of the duct during an incisional cholecystectomy.

Question 8 of 14 The nurse is caring for a client who had a Whipple surgical procedure yesterday. For what serum laboratory test results would the nurse want to monitor frequently and carefully? A. Blood glucose B. Blood urea nitrogen C. Phosphorus D. Platelet count

✅ANS: A Blood glucose During a Whipple procedure, most or all of the pancreas is manipulated, stressed, and possibly removed. Therefore, the client is at risk for hyperglycemia or hypoglycemia and blood glucose would need careful monitoring with a possible need for treatment.

2. A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the client daily.

✅ANS: B A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful. DIF: Applying/Application REF: 1179 KEY: Cirrhosis| nutritional requirements MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation Chapter 58: Care of Patients with Liver Problems iggy

Question 7 of 14 A client who had a Whipple surgical procedure develops an internal fistula between the pancreas and stomach. For which complication would the nurse monitor? A. Cirrhosis B. Crohn disease C. Peritonitis D. Peptic ulcer disease

✅ANS: C Peritonitis Leakage of pancreatic enzymes, bile, and/or gastric secretions into the abdomen (peritoneal cavity) often causes peritonitis, which requires IV antibiotic therapy to manage.

A nurse is caring for a client who has been diagnosed with cirrhosis. The client has been prescribed corticosteroids. Which information describes how this drug helps the cirrhotic liver? Select all that apply. Reduction in inflammation Polyuria Suppression of immune system liver destruction. Steady glucose levels Anemia

✅Reduction in inflammation Corticosteroids are often prescribed for clients with cirrhosis to suppress inflammation. Polyuria Corticosteroids do not cause excessive urination, nor does excessive urination help the patient with cirrhosis. ✅Suppression of immune system liver destruction Corticosteroids are often prescribed for clients with cirrhosis to slow immune-mediated liver destruction. Steady glucose levels Corticosteroids commonly alter a client's glucose level. Anemia Corticosteroids do not affect blood levels and therefore do not cause anemia.

A nurse is caring for a client that has been diagnosed with cirrhosis. Which of the following assessment findings is NOT consistent with this diagnosis? Scleral edema Asterixis Palmar erythema Hematemesis

✅Scleral edema Scleral edema is swelling of the sclera of the eye. This is NOT common in cirrhosis. The client may experience dependent peripheral edema due to volume overload. Asterixis Asterixis is a flapping hand tremor that is a common sign of cirrhosis and liver failure. Palmar erythema Palmar erythema is redness of the palms of the hand, which is consistent with cirrhosis. Hematemesis Hematemesis would be consistent with cirrhosis because these clients often have coagulopathies and are also at risk for esophageal varices, which would cause a client to vomit blood.

8. What test will be done before prescribing treatment for the patient with positive testing for HCV? a. Anti-HCV b. HCV genotyping c. FibroSure (FibroTest) d. HCV RNA quantitation

b. HCV genotyping is done to determine HCV drug choice, duration, and response to drug therapy. Anti-HCV and HCV RNA quantitation are tests completed to diagnose HCV. FibroSure (FibroTest) is used to assess the extent of hepatic fibrosis.

24. What laboratory test results should the nurse expect to find in a patient with cirrhosis? a. Serum albumin: 7.0 g/dL (70 g/L) b. Total bilirubin: 3.2 mg/dL (54.7 mmol/L) c. Serum cholesterol: 260 mg/dL (6.7 mmol/L) d. Aspartate aminotransferase (AST): 6.0 U/L (0.1 mkat/L)

b. Serum bilirubin, both direct and indirect, would be expected to be increased in cirrhosis. Serum albumin and cholesterol are decreased and liver enzymes, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT), are initially increased but may be normal in end- stage liver disease.

43. What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis? a. Has acute abdominal pain b. The need to abstain from alcohol c. Malabsorption and diabetes mellitus d. Require a high-carbohydrate, high-protein, low-fat diet

c. Chronic damage to the pancreas causes a deficiency of digestive enzymes and insulin resulting in malabsorption and diabetes. Abstinence from alcohol is necessary in both types of pancreatitis, as is a high- carbohydrate, high-protein, and low-fat diet. Although abdominal pain is a major manifestation of chronic pancreatitis, more commonly a constant heavy, gnawing feeling occurs. 44. a, b, c. Measures to prevent

6. The patient asks why the serologic test of HBV DNA quantitation is being done. What is the best explanation about the test for the nurse to explain to the patient? a. Shows an ongoing infection with HBV b. Indicates co-infection with HBV and HDV c. Determines any previous infection or immunization to HBV d. Indicates viral replication and effectiveness of therapy for chronic HBV

d. HBV DNA quantitation is the best indicator of viral replication and effectiveness of therapy for chronic HBV. HBsAg is present in acute or chronic infection. HBeAg shows high infectivity and can be used to determine clinical management of patients with chronic HBV. Anti-HBc IgM occurs with acute infection. Anti-HBc IgG indicates ongoing infection. Anti-HDV is present in past or current infection with HDV and therefore HBV. Anti-HBs indicate previous infection with HBV or immunization.

25. Malnutrition can be a major problem for patients with cirrhosis. Which nursing intervention can help improve nutrient intake? a. Oral hygiene before meals and snacks b. Provide all foods the patient likes to eat c. Improve oral intake by feeding the patient d. Limit snack offers to when the patient is hungry

25. a. Oral hygiene may improve the patient's taste sensation. Food preferences are important, but some foods may be restricted if the patient is on a low-sodium or low-fat diet. The patient will feel more independent with self-feeding and will be more likely to increase intake by having someone sit with the patient while the patient eats. Snacks and supplements should be available whenever the patient desires them but should not be forced on the patient.

28. Patient-Centered Care: To treat a cirrhotic patient with hepatic encephalopathy, lactulose, rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient's family wants to know why the laxative is ordered. What is the best explanation the nurse can give to the patient's family? a. Use reduces portal venous pressure. b. It will eliminate blood from the GI tract. c. It traps ammonia and eliminates it in the feces. d. It decreases bacteria to decrease ammonia formation.

c. Ammonia must be reduced to treat hepatic encephalopathy. The laxative, lactulose, decreases ammonia by trapping the ammonia and eliminating it in the feces. A β-adrenergic blocker will be used to decrease portal venous pressure and decrease variceal bleeding. The proton pump inhibitor will decrease gastric acidity but will not eliminate blood already in the GI tract. Rifaximin will decrease bacterial flora and therefore decrease ammonia formation from protein metabolism.

A nurse takes report in the morning for 4 clients with the following active diagnoses. Which client would be the priority to see first? Esophageal varices Cirrhosis Cholecystitis Pancreatitis

✅ Chapter 58: Care of Patients with Liver Problems iggy

Question 14 of 14 The nurse is reviewing laboratory results of a client recently admitted with a diagnosis of acute pancreatitis. Which values would the nurse expect to be elevated? (Select all that apply.) Select all that apply. A. Elastase B. Amylase C. Glucose D. Lipase E. Trypsin F. Calcium

✅ANS: A Elastase ✅ANS: B Amylase ✅ANS: C Glucose ✅ANS: D Lipase ✅ANS: E Trypsin The client who has acute pancreatitis experiences elevation of all pancreatic enzymes and glucose. The serum calcium level is usually decreased (rather than elevated) because the release of fatty acids combined with available calcium.

2. The patient had a blood transfusion reaction. What is the best explanation the nurse can give the patient as to why hemolytic jaundice has occurred? a. A malaria parasite has broken apart red blood cells (RBCs) b. It results from liver's altered ability from hepatocellular disease c. Jaundice results from decreased flow of bile through the liver or biliary system d. It is caused by increased breakdown of RBCs that increases serum unconjugated bilirubin

2. d. Hemolytic jaundice from a blood transfusion reaction is from increased breakdown of red blood cells (RBCs) producing increased unconjugated bilirubin in the blood. Hepatocellular jaundice results from damaged hepatocytes leaking bilirubin. Hemolytic jaundice occurs with malaria. Obstructive jaundice is from obstructed bile flow through the liver or biliary duct system.

15. The nurse identifies a need for further teaching when the patient with acute hepatitis B makes which statement? a. "I should avoid alcohol completely for at least a year." b. "I must avoid all physical contact with my family until the jaundice is gone." c. "I should use a condom to prevent spread of the disease to my sexual partner." d. "I will need to rest several times a day, gradually increasing my activity as I tolerate it."

b. The patient with acute hepatitis B is infectious for 4 to 6 months, and precautions to prevent transmission through percutaneous and sexual contact should be maintained until tests for Hbs Ag or anti-HBc IgM are negative. Close contact does not have to be avoided, but close contacts of the patient should be vaccinated. Alcohol should not be used for at least a year, and rest with increasing activity during convalescence is recommended.

7. Although HAV antigens are not tested in the blood, they stimulate specific IgM and IgG antibodies. Which antibody indicates there is acute HAV infection? a. Anti-HBc IgG b. Anti-HBc IgM c. Anti-HAV IgG d. Anti-HAV IgM

d. Anti-HAV IgM indicates acute HAV infection. Anti-HBc IgG indicates previous or ongoing infection with HBV. Anti-HBc IgM indicates acute HBV infection. Anti-HAV IgG indicates previous infection with HAV.

5. 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. Blood amylase 80 units/L B. WBC 9,000/mm3 C. direct bilirubin 2.1 mg/dL D. Alkaline phosphatase 25 units/L

A. expect the client who has cholelithiasis to have an elevated blood amylase level if pancreatic involvement is present. A blood amylase of 80 units/L is within the expected reference range. B. expect the client who has cholelithiasis to have an elevated WBC level due to inflammation. A WBC of 9,000/mm3 is within the expected reference range. ✅C. CORRECT: 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 above the expected reference range. D. expect the client who has cholelithiasis to have an elevated alkaline phosphatase (ALP) level if the common bile duct is obstructed. An ALP of 25 units/L is less than the expected reference range. NCLEX® Connection: Reduction of Risk Potential, Laboratory Values CH 53 CHOLECYSTITIS AND CHOLELITHIASIS

18. The patient has been newly diagnosed with Wilson's disease. D-penicillamine, a chelating agent, has been prescribed. What assessment finding should the nurse expect? a. Pruritus b. Acute kidney injury c. Corneal Fleischer rings d. Increased serum iron levels

c. Corneal Fleischer rings, brownish red rings in the cornea near the limbus, are the hallmark of Wilson's disease. Pruritus (not seen with Wilson's disease) is commonly seen with jaundice or primary biliary cirrhosis. Renal failure associated with hepatorenal syndrome is not seen with Wilson's disease. High serum iron levels are seen with hemochromatosis.

29. Priority Decision: The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe? a. Turn the patient every 3 hours. b. Encourage increasing ambulation. c. Assist the patient to the bathroom. d. Prevent constipation to reduce ammonia production.

c. The patient may not be oriented or able to walk to the bathroom alone because of hyperreflexia, asterixis, or decreased motor coordination. Turning should be done every 2 hours to prevent skin breakdown. Activity is limited to decrease ammonia as a by-product of protein metabolism. Although constipation will be prevented, it will not keep the patient safe.

11. The occurrence of acute liver failure is most common in which situation? a. A person with hepatitis A b. A person with hepatitis C c. Antihypertensive medication use d. Use of acetaminophen with alcohol use

d. The most common cause of acute liver failure is drugs, usually acetaminophen in combination with alcohol. HBV is the second most common cause. HAV is a less common cause.

5. A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin) for bleeding esophageal varices. Which clinical manifestation should alert the nurse to a serious adverse effect? a. Nausea and vomiting b. Frontal headache c. Vertigo and syncope d. Mid-sternal chest pain

✅ANS: D Mid-sternal chest pain is indicative of acute angina or myocardial infarction, which can be precipitated by vasopressin. Nausea and vomiting, headache, and vertigo and syncope are not side effects of vasopressin. DIF: Applying/Application REF: 1177 KEY: Hemorrhaging| cirrhosis| vascular perfusion MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 58: Care of Patients with Liver Problems iggy

3. A nurse is completing 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."

A. surgery is possibly performed through the rectum during the natural orifice transluminal endoscopic surgery (NOTes) approach. ✅B. CORRECT: shoulder pain is expected postoperatively due to free air that is introduced into the abdomen during laparoscopic surgery. C. A Jackson‐Pratt can be placed during the open surgery approach. D. The client is instructed to ambulate frequently following a laparoscopic surgical approach to minimize the free air that has been introduced. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures CH 53 CHOLECYSTITIS AND CHOLELITHIASIS

A nurse is presenting a program on gallbladder disease to a group of clients at a health fair. What information should the nurse include in the program? Use the ATi Active Learning Template: system disorder to complete this item. RISK FACTORS: describe at least four. EXPECTED FINDINGS: describe at least eight findings. CLIENT EDUCATION: describe three preventative activities.

Using the ATI Active Learning Template: System Disorder RISK FACTORS ● Female sex ● estrogen therapy and some oral contraceptives ● High‐fat or low‐calorie, liquid protein diets ● Obesity ● Genetic predisposition ● Age over 60 years ● Type 2 diabetes mellitus ● rapid weight loss ● Native American or Mexican American ethnicity EXPECTED FINDINGS ● sharp pain in the right upper quadrant that often radiates to the right shoulder ● Pain upon deep inspiration during right subcostal palpation ● intense pain with nausea and vomiting after ingestion of high‐fat food ● dyspepsia ● eructation (belching) ● Flatulence ● Fever ● Jaundice ● Clay‐colored stools ● steatorrhea (fatty stools) ● dark urine ● Pruritus CLIENT EDUCATION ● Get regular exercise. ● stop using tobacco products. ● Consume a low‐fat diet rich in HdL sources (seafood, nuts, olive oil). NCLEX® Connection: Physiological Adaptation, Pathophysiology CH 53 CHOLECYSTITIS AND CHOLELITHIASIS

16. What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis? a. Providing adequate nutritional intake b. Promoting strict bed rest during the icteric phase c. Providing pain relief without using liver metabolized drugs d. Providing quiet diversional activities during periods of fatigue

a. Adequate nutrition is especially important in promoting regeneration of liver cells, but the anorexia of viral hepatitis is often severe, requiring creative and innovative nursing interventions. Strict bed rest is not usually required, and the patient usually has only minor discomfort with hepatitis. Diversional activities may be required to promote psychologic rest but not during periods of fatigue.

4. Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer? a. HAV b. HBV c. HCV d. HEV

b. Hepatitis B virus (HBV) is a DNA virus that is transmitted via infectious blood and body products and is required for hepatitis D virus (HDV) replication, and chronic HBV along with chronic hepatitis C virus (HCV) accounts for 80% of hepatocellular cancer cases. Hepatitis A virus (HAV), HCV, HDV, and HEV are all RNA viruses.

The nurse is caring for a cirrhotic client with jaundice. Which of the following is a nursing priority? Administer lactulose Expose to UV light to reduce jaundice Bathe in Epsom salts Apply baking soda paste to the skin

✅Administer lactulose Lactulose reduces ammonia in the body, which can build up when the live does not function properly. Expose to UV light to reduce jaundice This intervention is only effective for infants with neonatal jaundice. Bathe in Epsom salts The client can bathe in baking soda or alpha Keri baths to relieve itching associated with cirrhosis, but neither baking soda paste nor Epsom salts will help. Apply baking soda paste to the skin The client can bathe in baking soda or alpha Keri baths to relieve itching associated with cirrhosis, but neither baking soda paste nor Epsom salts will help.

A client is suffering from fluid overload due to a history of severe liver disease. Which of the following interventions would be the highest priority for this client? Monitor for heart arrhythmias and the presence of crackles on auscultation Weigh the client daily Elevate the lower extremities to reduce edema Check skin regularly for signs of skin breakdown

✅Monitor for heart arrhythmias and the presence of crackles on auscultation Fluid overload can develop as a result of various types of disease processes. It can lead to edema, weight gain, and electrolyte imbalance. To avoid complications of fluid overload, the nurse should listen to the client's heart rate to determine if excess fluid has caused heart arrhythmias. The nurse should also listen to the client's breath sounds for signs of breathing difficulties because of increased fluid. Weigh the client daily While monitoring the client's daily weights is helpful, it is not an urgent priority for a client with fluid overload. Elevate the lower extremities to reduce edema This is not the highest priority, because this is unrelated to breathing and circulation. Monitoring for heart arrhythmias and lung crackles are MOST important because these assessments indicate an affect on the cardiac and respiratory systems. These body systems must be addressed FIRST. Check skin regularly for signs of skin breakdown Skin breakdown is not a priority in this client at this time.

4. A nurse is reviewing a new prescription for chenodiol 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 clients who have diabetes mellitus. D. This medication dissolves gallstones gradually over a period of up to 2 years.

A. Opioid analgesics are preferred for the treatment of acute biliary pain. B. The client should have an ultrasound of the gallbladder every 6 months during the first year of treatment to determine effectiveness of the medication. C. Chenodiol is used cautiously in clients who have hepatic conditions or disorders with varices. ✅D. CORRECT: Chenodiol is a bile acid that gradually dissolves cholesterol‐based gall stones. The medication can be taken for up to 2 years. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration CH 53 CHOLECYSTITIS AND CHOLELITHIASIS

1. A nurse is providing discharge teaching to a client who is postoperative following a laparoscopic cholecystectomy. Which of the following instructions should the nurse include in the teaching? (select all that apply.) A. Take baths rather than showers. B. resume a diet of choice. C. Cleanse the puncture site using mild soap and water. d. remove adhesive strips from the puncture site in 24 hr. e. report nausea and vomiting to the surgeon.

A. The client can take a bath or shower within 1 to 2 days following surgery. ✅B. CORRECT: The client is able to resume a regular diet of choice upon discharge. ✅C. CORRECT: The client should cleanse the puncture site with mild soap and water to decrease the risk of infection. d. The adhesive strips covering the puncture site should remain in place until they fall off naturally. ✅e. CORRECT: The client should report nausea, vomiting, or abdominal pain to the surgeon. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures CH 53 CHOLECYSTITIS AND CHOLELITHIASIS

30. A patient with advanced cirrhosis has a nursing diagnosis of impaired low nutritional intake because of anorexia and an inadequate food intake. What would be an appropriate midday snack for the patient? a. Peanut butter and salt-free crackers b. A fresh tomato sandwich with salt-free butter c. Popcorn with salt-free butter and herbal seasoning d. Canned chicken noodle soup with low-protein bread

b. The patient with advanced, complicated cirrhosis requires a high- calorie, high-carbohydrate diet with moderate to low fat. Patients with cirrhosis are at risk for edema and ascites, and their sodium intake may be limited. The tomato sandwich with salt-free butter best meets these requirements. Rough foods, such as popcorn, may irritate the esophagus and stomach and lead to bleeding. Peanut butter is high in sodium and fat, and canned chicken noodle soup is very high in sodium.

35. A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge? a. Chemotherapy is highly successful in the treatment of liver cancer. b. The patient will undergo surgery to remove the involved portions of the liver. c. Supportive care that is appropriate for all patients with severe liver damage is indicated. d. Metastatic cancer of the liver is more responsive to treatment than primary carcinoma of the liver.

c. Because the prognosis for cancer of the liver is poor and treatment is largely palliative, supportive nursing care is appropriate. The patient exhibits clinical manifestations of liver failure, as seen in any patient with advanced liver failure. Whether the cancer is primary or metastatic, there is usually a poor response to chemotherapy and surgery is indicated in the few patients that have localization of the tumor when there is no evidence of invasion of hepatic blood vessels.

32. Priority Decision: During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do? a. Prepare the patient for immediate portal shunting surgery. b. Perform guaiac testing on all stools to detect occult blood. c. Maintain the patient's airway and prevent aspiration of blood. d. Monitor for the cardiac effects of IV vasopressin and nitroglycerin.

c. Bleeding esophageal varices are a medical emergency. During an episode of bleeding, management of the airway and prevention of aspiration of blood are critical factors. Portal shunting surgery may be done for esophageal varices but not during an acute hemorrhage. Occult blood as well as fresh blood from the GI tract would be expected. Vasopressin causes vasoconstriction, decreased heart rate, and decreased coronary blood flow. IV nitroglycerin may be given with the vasopressin to counter these side effects.

22. Which etiologic manifestations occur in the patient with cirrhosis related to esophageal varices? a. Jaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction b. Loss of the small bile ducts and cholestasis and cirrhosis in patients with other autoimmune disorders c. Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension d. Scarring and nodular changes in the liver lead to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein

c. Esophageal varices occur when collateral channels of circulation develop inelastic fragile veins from portal hypertension. Portal hypertension is from scarring and nodular changes in the liver leading to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein. It contributes to peripheral edema and ascites. Jaundice is from the inability of the liver to conjugate bilirubin. Biliary cirrhosis causes the loss of small bile ducts and ultimate cholestasis in patients with other autoimmune disorders.

5. Serologic findings in viral hepatitis include both the presence of viral antigens and antibodies produced in response to the viruses. What laboratory result indicates that the nurse is immune to HBV after vaccination? a. Anti-HBc immunoglobulin (Ig)G b. Surface antigen HBs Ag c. Surface antibody anti-HBs d. Core antigen anti-HBc IgM

c. Immunization to HBV after vaccination is identified with the hepatitis B surface antibody (anti-HBs). Anti-HBc immunoglobulin (Ig)G indicates previous or ongoing HBV infection. Surface antigen HBsAg is present in acute and chronic infection. Core antigen anti-HBc IgM indicates acute infection and does not appear after vaccination.

17. When caring for a patient with autoimmune hepatitis, the nurse understands that what about this patient is different from the patient who has viral hepatitis? a. Does not manifest hepatomegaly or jaundice b. Experiences less liver inflammation and damage c. Is treated with corticosteroids or other immunosuppressive agents d. Is an older adult who has used a wide variety of prescription and over-the-counter drugs

c. Immunosuppressive agents are indicated in hepatitis associated with immune disorders to decrease liver damage caused by autoantibodies. Autoimmune hepatitis is similar to viral hepatitis in presenting signs and symptoms and may become chronic and lead to cirrhosis.

14. A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse? a. "Only chronic hepatitis C is treatable and primarily with antiviral agents and interferon." b. "There are no specific drug therapies that are effective for treating acute viral hepatitis." c. "Lamivudine (Epivir) and interferon both decrease viral load and help prevent complications." d. "No drugs are used for the treatment of viral hepatitis because of the risk of additional liver damage."

c. Nucleoside and nucleotide analogs (e.g., lamivudine) and pegylated interferon are used to treat chronic hepatitis B. No specific drugs are effective in treating acute viral hepatitis, although supportive drugs, such as antiemetics, sedatives, or antipruritics, may be used for symptom control.

40. What treatment measure is used in managing the patient with acute pancreatitis? a. Surgery to remove the inflamed pancreas b. Pancreatic enzyme supplements administered with meals c. Nasogastric (NG) suction to prevent gastric contents from entering the duodenum d. Endoscopic pancreatic sphincterotomy using endoscopic retrograde cholangiopancreatography (ERCP)

c. Pancreatic rest and suppression of secretions are promoted by preventing any gastric contents from entering the duodenum, which would stimulate pancreatic activity. Surgery is not indicated for acute pancreatitis but may be used to drain abscesses or cysts. Pancreatic enzyme supplements are necessary in chronic pancreatitis if a deficiency in secretion occurs, but not for acute pancreatitis. An endoscopic retrograde cholangiopancreatography (ERCP) pancreatic sphincterotomy may be done when pancreatitis is related to gallstones.

42. Patient-Centered Care: The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis makes which statement? a. "I should observe for fat in my stools." b. "I must not use alcohol to prevent future attacks of pancreatitis." c. "I shouldn't eat any salty foods or foods with high amounts of sodium." d. "I will not need to monitor my blood glucose levels when I am at home."

c. Sodium restriction is not indicated for patients recovering from acute pancreatitis, but fat is restricted. The stools should be observed for steatorrhea, indicating that fat digestion is impaired. Alcohol is a primary cause of pancreatitis and should not be used. Glucose levels are monitored for chronic pancreatitis.

37. Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis? a. Tetany b. Pseudocyst c. Pleural effusion d. Pancreatic abscess

d. A pancreatic abscess, usually from an infected pseudocyst, is a collection of pus that must be drained to prevent infection of adjacent organs and sepsis. Tetany from hypocalcemia is treated with IV calcium gluconate (10%). Although pseudocysts usually resolve spontaneously, they may be treated with surgical, percutaneous catheter, or endoscopic drainage to prevent perforation. Pleural effusion is treated by treating the cause (pancreatitis) and monitoring for respiratory distress and oxygen saturation.

23. Which conditions contribute to the formation of abdominal ascites? a. Esophageal varices contribute to 80% of variceal hemorrhages b. Increased colloidal oncotic pressure caused by decreased albumin production c. Hypoaldosteronism causes increased sodium reabsorption by the renal tubules d. Blood flow through the portal system is obstructed, which causes portal hypertension

d. Blood flow through the portal system is obstructed and causes portal hypertension that increases the BP in the portal venous system. Decreased albumin production leads to decreased serum colloidal oncotic pressure that contributes to ascites. Hyperaldosteronism increases sodium and water retention and contributes to increased fluid retention, hypokalemia, and decreased urinary output. The retained fluid has low oncotic colloidal pressure. It escapes into the interstitial spaces, causing peripheral edema. Portal hypertension contributes to esophageal varices. Reduced renal blood flow and increased serum levels of antidiuretic hormone (ADH) contribute to impaired water excretion and ascites.

33. A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a splenorenal shunt. Because of this procedure, what should the nurse expect the patient to experience? a. An improved survival rate b. Decreased serum ammonia levels c. Improved metabolism of nutrients d. Improved hemodynamic function and renal perfusion

d. By shunting fluid sequestered in the portal vein into the venous system, pressure on esophageal veins is decreased and more volume is returned to the circulation, improving cardiac output and renal perfusion. However, because ammonia is diverted past the liver, hepatic encephalopathy may occur. These procedures do not prolong life or promote liver function.

27. What patient manifestation does the nurse recognize as an early sign of hepatic encephalopathy? a. Manifests asterixis b. Becomes unconscious c. Has increasing oliguria d. Impaired computational skills

d. Early signs (grade 1) of this neurologic condition include impaired computational skills, short attention span, personality change, decreased short-term memory, mild confusion, depression, and incoordination. Loss of consciousness (grade 4) is usually preceded by asterixis, abnormal reflexes, and disoriented to time (grades 2 and 3); inappropriate behavior, deficient executive function, marked confusion, loss of meaningful conversation, and incomprehensible speech. Increasing oliguria is a sign of hepatorenal syndrome.

31. The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant? a. Alcohol intake is now okay. b. HBIG will be required to prevent rejection. c. Elevate the head 30 degrees to improve ventilation when sleeping. d. Monitor closely for infection because of the immunosuppressive medication.

d. Monitoring for viral, fungal, and bacterial infection after the liver transplant is essential, as only fever may be present with an infection. Alcohol will not be any better for the patient after the transplant than it was before the transplant. HBIG is given for postexposure protection from HBV. The head of the bed is elevated to improve ventilation with severe ascites.

19. The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What is the most likely diagnosis the nurse should expect for this patient? a. Cirrhosis b. Acute liver failure c. Hepatorenal syndrome d. Primary sclerosing cholangitis

d. Most patients with primary sclerosing cholangitis (PSC) also have ulcerative colitis. The manifestations are otherwise similar to cirrhosis, and PSC may lead to cirrhosis, liver failure, and liver cancer.

38. When assessing a patient with acute pancreatitis, the nurse would expect to find a. hyperactive bowel sounds. b. hypertension and tachycardia. c. a temperature greater than 102° F (38.9° C). d. severe left upper quadrant (LUQ) or midepigastric pain.

d. The predominant symptom of acute pancreatitis is severe, deep abdominal pain that is usually located in the left upper quadrant (LUQ) but may be in the midepigastrium. Bowel sounds are decreased or absent, the patient is hypotensive and may manifest symptoms of shock, and there is only a low-grade fever.

9. What causes the systemic effects of viral hepatitis? a. Toxins produced by the infected liver b. Impaired portal circulation from fibrosis c. Cholestasis from chemical hepatotoxicity d. Complement system activation by antigen-antibody complexes

d. The systemic manifestations of rash, angioedema, arthritis, fever, and malaise in viral hepatitis are caused by the activation of the complement system by circulating immune complexes. Liver manifestations include jaundice from hepatic cell damage and cholestasis as well as anorexia. Impaired portal circulation usually does not occur in uncomplicated viral hepatitis but would be a liver manifestation.

5. A nurse plans care for a client who has hepatopulmonary syndrome. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Oxygen therapy b. Prone position c. Feet elevated on pillows d. Daily weights e. Physical therapy

✅ANS: A, C, D Care for a client who has hepatopulmonary syndrome should include oxygen therapy, the head of bed elevated at least 30 degrees or as high as the client wants to improve breathing, elevated feet to decrease dependent edema, and daily weights. There is no need to place the client in a prone position, on the clients stomach. Although physical therapy may be helpful to a client who has been hospitalized for several days, physical therapy is not an intervention specifically for hepatopulmonary syndrome. DIF: Applying/Application REF: 1172 KEY: Cirrhosis| respiratory distress/failure MSC: Integrated Process: Nursing Process: Planning NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort Chapter 58: Care of Patients with Liver Problems iggy

6. An emergency room nurse assesses a client with potential liver trauma. Which clinical manifestations should alert the nurse to internal bleeding and hypovolemic shock? (Select all that apply.) a. Hypertension b. Tachycardia c. Flushed skin d. Confusion e. Shallow respirations

✅ANS: B, D Symptoms of hemorrhage and hypovolemic shock include hypotension, tachycardia, tachypnea, pallor, diaphoresis, cool and clammy skin, and confusion. DIF: Remembering/Knowledge REF: 1185 KEY: Abdominal trauma| emergency nursing MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation Chapter 58: Care of Patients with Liver Problems iggy

CHOLECYSTITIS AND CHOLELITHIASIS- COMPLICATIONS

⏺Obstruction of the bile duct This can cause ischemia, gangrene, and a rupture of the gallbladder wall. A rupture of the gallbladder wall can cause a local abscess or peritonitis (rigid, board-like abdomen, guarding), which requires a surgical intervention and administration of broad spectrum antibiotics. ⏺Bile peritonitis This can occur if adequate amounts of bile are not drained from the surgical site. This is a rare but potentially fatal complication. NURSING ACTIONS ● Monitor for pain, fever, and jaundice. ● Report findings to the provider immediately. ⏺Postcholecystectomy syndrome Manifestations of gallbladder disease can continue after surgery. The client should report findings similar to those experienced prior to surgery related to pain and nausea. Manifestations can recur immediately or months later. NURSING ACTIONS: Assess pain characteristics and other reported findings. CLIENT EDUCATION: Possible further diagnostic evaluation can be needed. ● Older adults (decreased gall bladder contractility, more likely to develop gallstones) ● OLDER ADULT CLIENTS can have atypical presentation of cholecystitis (absence of pain or fever). Delirium might be the initial manifestation, or the client might have localized tenderness. CH 53 CHOLECYSTITIS AND CHOLELITHIASIS

A nurse receives a client from radiology that just underwent a liver biopsy. Which position should the nurse place the client in to decrease risk of bleeding? Right side-lying Left side-lying High-Fowler's Prone

✅ Right side-lying The goal is to place pressure over the liver, which is located on the right side of the abdominal cavity. It would also be beneficial to add a pillow underneath the area of the liver to place extra pressure to prevent bleeding. Left side-lying This would leave the liver without any pressure on it, therefore increasing the risk for bleeding. High-Fowler's Although this may be a comfortable position and improve breathing, it will not help prevent bleeding after a liver biopsy. Prone Lying on the stomach would not help prevent bleeding after a liver biopsy

2. A nurse is reviewing risk factors with a client who has cholecystitis. The nurse should identify that which of the following as a risk factor for cholecystitis? A. Obesity B. rapid weight gain C. decreased blood triglyceride level d. Male sex

✅A. CORRECT: Obesity is considered a risk factor for the development of cholecystitis. B. rapid weight loss is a risk factor for the development of cholecystitis. C. increased blood cholesterol levels are a risk factor for developing cholecystitis. d. Female sex is a risk factor for the development of cholecystitis. NCLEX® Connection: Reduction of Risk Potential CH 53 CHOLECYSTITIS AND CHOLELITHIASIS

9. A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B? a. A 20-year-old college student who has had several sexual partners b. A 46-year-old woman who takes acetaminophen daily for headaches c. A 63-year-old businessman who travels frequently across the country d. An 82-year-old woman who recently ate raw shellfish for dinner

✅ANS: A Hepatitis B can be spread through sexual contact, needle sharing, needle sticks, blood transfusions, hemodialysis, acupuncture, and the maternal-fetal route. A person with multiple sexual partners has more opportunities to contract the infection. Hepatitis B is not transmitted through medications, casual contact with other travelers, or raw shellfish. Although an overdose of acetaminophen can cause liver cirrhosis, this is not associated with hepatitis B. Hepatitis E is found most frequently in international travelers. Hepatitis A is spread through ingestion of contaminated shellfish. DIF: Understanding/Comprehension REF: 1180 KEY: Hepatitis| health screening MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Health Promotion and Maintenance Chapter 58: Care of Patients with Liver Problems iggy

3. A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a. Urine output via indwelling urinary catheter is 20 mL/hr b. Blood pressure increases from 110/58 to 120/62 mm Hg c. Respiratory rate decreases from 18 to 14 breaths/min d. A decrease in the clients weight by 6 kg

✅ANS: A Rapid removal of ascetic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the clients weight to drop as fluid is removed. Six kilograms is less than 3 pounds and is expected. DIF: Applying/Application REF: 1176 KEY: Hydration| hemodynamics| cirrhosis MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential Chapter 58: Care of Patients with Liver Problems iggy

16. A nurse cares for a client with hepatopulmonary syndrome who is experiencing dyspnea with oxygen saturations at 92%. The client states, I do not want to wear the oxygen because it causes my nose to bleed. Get out of my room and leave me alone! Which action should the nurse take? a. Instruct the client to sit in as upright a position as possible. b. Add humidity to the oxygen and encourage the client to wear it. c. Document the clients refusal, and call the health care provider. d. Contact the provider to request an extra dose of the clients diuretic.

✅ANS: A The client with hepatopulmonary syndrome is often dyspneic. Because the oxygen saturation is not significantly low, the nurse should first allow the client to sit upright to see if that helps. If the client remains dyspneic, or if the oxygen saturation drops further, the nurse should investigate adding humidity to the oxygen and seeing whether the client will tolerate that. The other two options may be beneficial, but they are not the best choices. If the client is comfortable, his or her agitation will decrease; this will improve respiratory status. DIF: Applying/Application REF: 1176 KEY: Cirrhosis| respiratory distress/failure MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential Chapter 58: Care of Patients with Liver Problems iggy

7. A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, I do not want to take this medication because it causes diarrhea. How should the nurse respond? a. Diarrhea is expected; thats how your body gets rid of ammonia. b. You may take Kaopectate liquid daily for loose stools. c. Do not take any more of the medication until your stools firm up. d. We will need to send a stool specimen to the laboratory

✅ANS: A The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse should not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication. DIF: Applying/Application REF: 1178 KEY: Cirrhosis| medication| coping MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 58: Care of Patients with Liver Problems iggy

10. A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this clients discharge education? a. Use a pill organizer to ensure you take this medication as prescribed. b. Transient muscle aching is a common side effect of this medication. c. Follow up with your provider in 1 week to test your blood for toxicity. d. Take your radial pulse for 1 minute prior to taking this medication.

✅ANS: A Treatment of hepatitis C with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. Muscle aching is not a common side effect. The client will be on this medication for many weeks and does not need a blood toxicity examination. There is no need for the client to assess his or her radial pulse prior to taking the medication. DIF: Applying/Application REF: 1184 KEY: Hepatitis| medication MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 58: Care of Patients with Liver Problems iggy

Question 3 of 14 The nurse is caring for a client who recently had an external percutaneous transhepatic biliary catheter placed for severe biliary obstruction. What is the nurse's priority intervention when caring for this client? A. Keeping the biliary drainage bag below the level of the catheter-insertion site B. Checking the client's blood glucose frequently to monitor for diabetes C. Managing pain with continuous opioid patient-controlled analgesia (PCA) D. Capping the catheter if it starts to leak around the insertion site

✅ANS: A Keeping the biliary drainage bag below the level of the catheter-insertion site The client who has an external percutaneous transhepatic biliary catheter drains by gravity and therefore needs to have the drainage bag placed lower that the catheter-insertion site. The catheter is not capped if jaundice or leakage around the catheter site occurs. Opioids are not needed while the client has the catheter; however, if it is in place for an extended period of time, it needs to be changed.

Question 1 of 14 The nurse is caring for a client who states that her mother had "gallbladder problems" and wonders if she is at risk for this disorder. What major risk factor places women most at risk for gallbladder disease? A. Obesity B. Birth control pills C. Infertility D. Advanced age

✅ANS: A Obesity Obese women who are middle age and have had multiple children are at the highest risk for gallbladder disease, although it can occur in anyone.

Question 6 of 14 A client is admitted to the emergency department with possible acute pancreatitis. What is the nurse's priority assessment at this time? A. Respiratory assessment B. Cardiovascular assessment C. Abdominal assessment D. Pain intensity assessment

✅ANS: A Respiratory assessment As for any client, the nurse would want to continually assess for airway, breathing, and circulation. Clients who have acute pancreatitis often develop pleural infusions, atelectasis, or pneumonia. Necrotizing hemorrhagic pancreatitis places the client at risk for acute respiratory distress syndrome (ARDS).

Question 12 of 14 The nurse is preparing to instruct a client with chronic pancreatitis who is to begin taking pancrelipase. Which instruction does the nurse include when teaching the client about this medication? A. Wipe your lips after taking pancrelipase. B. Take pancrelipase before meals. C. Administer pancrelipase before taking an antacid. D. Chew tablets before swallowing.

✅ANS: A Wipe your lips after taking pancrelipase. The nurse will instruct the client to wipe the lips after taking pancrelipase. Pancrelipase is a pancreatic enzyme used for enzyme replacement for clients with chronic pancreatitis. To avoid skin irritation and breakdown from residual enzymes, the lips should be wiped. Pancrelipase should be administered after, and not before, antacids or histamine2 blockers are taken. It should not be chewed to minimize oral irritation and allow the drug to be released more slowly. It should be taken with meals and snacks, and not before, and followed with a glass of water.

4. A nurse assesses a male client who has symptoms of cirrhosis. Which questions should the nurse ask to identify potential factors contributing to this laboratory result? (Select all that apply.) a. How frequently do you drink alcohol? b. Have you ever had sex with a man? c. Do you have a family history of cancer? d. Have you ever worked as a plumber? e. Were you previously incarcerated?

✅ANS: A, B, E When assessing a client with suspected cirrhosis, the nurse should ask about alcohol consumption, including amount and frequency; sexual history and orientation (specifically men having sex with men); illicit drug use; history of tattoos; and history of military service, incarceration, or work as a firefighter, police officer, or health care provider. A family history of cancer and work as a plumber do not put the client at risk for cirrhosis. DIF: Applying/Application REF: 1176 KEY: Cirrhosis| laboratory values MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation Chapter 58: Care of Patients with Liver Problems iggy

3. A nurse delegates hygiene care for a client who has advanced cirrhosis to an unlicensed nursing personnel (UAP). Which statements should the nurse include when delegating this task to the UAP? (Select all that apply.) a. Apply lotion to the clients dry skin areas. b. Use a basin with warm water to bathe the client. c. For the clients oral care, use a soft toothbrush. d. Provide clippers so the client can trim the fingernails. e. Bathe with antibacterial and water-based soaps.

✅ANS: A, C, D Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush should be used to prevent gum bleeding, and the clients nails should be trimmed short to prevent the client from scratching himself or herself. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap. DIF: Remembering/Knowledge REF: 1176 KEY: Cirrhosis| delegation| unlicensed assistive personnel (UAP) MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort Chapter 58: Care of Patients with Liver Problems iggy

1. An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan? (Select all that apply.) a. Policies related to consistent use of Standard Precautions b. Hepatitis vaccination mandate for workers in high-risk areas c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner

✅ANS: A, C, D, E Nurses should always use Standard Precautions for client care, and policies should reflect this. Needleless systems and reduction of sharps can help prevent hepatitis. Postexposure prophylaxis should be provided immediately. All health care workers should receive the hepatitis vaccinations that are available. DIF: Applying/Application REF: 1182 KEY: Hepatitis| infection control| policy MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control Chapter 58: Care of Patients with Liver Problems iggy

6. A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond? a. A low-protein diet will help the liver rest and will restore liver function. b. Less protein in the diet will help prevent confusion associated with liver failure. c. Increasing dietary protein will help the client gain weight and muscle mass. d. Low dietary protein is needed to prevent fluid from leaking into the abdomen.

✅ANS: B A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing the clients dietary protein will cause complications of liver failure and should not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein. DIF: Applying/Application REF: 1171 KEY: Cirrhosis| nutritional requirements| support MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort Chapter 58: Care of Patients with Liver Problems iggy

1. A nurse obtains a clients health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this client? a. I drink two glasses of red wine each week. b. I take a lot of Tylenol for my arthritis pain. c. I have a cousin who died of liver cancer. d. I got a hepatitis vaccine before traveling.

✅ANS: B Acetaminophen (Tylenol) can cause liver damage if taken in large amounts. Clients should be taught not to exceed 4000 mg/day of acetaminophen. The nurse should teach the client about this limitation and should explore other drug options with the client to manage his or her arthritis pain. Two glasses of wine each week, a cousin with liver cancer, and the hepatitis vaccine do not place the client at risk for a liver disorder, and therefore do not require any health teaching. DIF: Applying/Application REF: 1179 KEY: Cirrhosis| acetaminophen| medication safety MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 58: Care of Patients with Liver Problems iggy

19. A nurse cares for a client with hepatitis C. The clients brother states, I do not want to contract this infection, so I will not go into his hospital room. How should the nurse respond? a. If you wear a gown and gloves, you will not get this virus. b. Viral hepatitis is not spread through casual contact. c. This virus is only transmitted through a fecal specimen. d. I can give you an update on your brothers status from here.

✅ANS: B Although family members may be afraid that they will contract hepatitis C, the nurse should educate the clients family about how the virus is spread. Viral hepatitis, or hepatitis C, is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needle sticks, unsanitary tattoo equipment, and sharing of intranasal cocaine paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the clients status with the brother. DIF: Applying/Application REF: 1181 KEY: Hepatitis| infection control MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control Chapter 58: Care of Patients with Liver Problems iggy

15. After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I cannot drink any alcohol at all anymore. b. I need to avoid protein in my diet. c. I should not take over-the-counter medications. d. I should eat small, frequent, balanced meals.

✅ANS: B Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client. DIF: Applying/Application REF: 1174 KEY: Cirrhosis| nutritional requirements MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Health Promotion and Maintenance Chapter 58: Care of Patients with Liver Problems iggy

14. A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, I am experiencing right flank pain and have a temperature of 101 F. How should the nurse respond? a. The anti-rejection drugs you are taking make you susceptible to infection. b. You should go to the hospital immediately to have your new liver checked out. c. You should take an additional dose of cyclosporine today. d. Take acetaminophen (Tylenol) every 4 hours until you feel better.

✅ANS: B Fever, right quadrant or flank pain, and jaundice are signs of liver transplant rejection; the client should be admitted to the hospital as soon as possible for intervention. Anti-rejection drugs do make a client more susceptible to infection, but this client has signs of rejection, not infection. The nurse should not advise the client to take an additional dose of cyclosporine or acetaminophen as these medications will not treat the acute rejection. DIF: Applying/Application REF: 1187 KEY: Organ transplantation MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care Chapter 58: Care of Patients with Liver Problems iggy

17. A nurse cares for a client who is scheduled for a paracentesis. Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)? a. Have the client sign the informed consent form. b. Assist the client to void before the procedure. c. Help the client lie flat in bed on the right side. d. Get the client into a chair after the procedure.

✅ANS: B For safety, the client should void just before a paracentesis. The nurse or the provider should have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the side of the bed and leaning over the bedside table. The client will be on bedrest after the procedure. Chapter 58: Care of Patients with Liver Problems iggy

12. An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel mark across the clients chest. Which action should the nurse take? a. Ask the client where in the car he or she was sitting during the crash. b. Assess the client by gently palpating the abdomen for tenderness. c. Notify the laboratory to draw blood for blood type and crossmatch. d. Place the client on the stretcher in reverse Trendelenburg position.

✅ANS: B The liver is often injured by a steering wheel in a motor vehicle crash. Because the clients chest was marked by the steering wheel, the nurse should perform an abdominal assessment. Assessing the clients position in the crash is not needed because of the steering wheel imprint. The client may or may not need a blood transfusion. The client does not need to be in reverse Trendelenburg position. DIF: Applying/Application REF: 1185 KEY: Abdominal trauma| emergency nursing MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care Chapter 58: Care of Patients with Liver Problems iggy

8. After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching? a. Some medications have been known to cause hepatitis A. b. I may have been exposed when we ate shrimp last weekend. c. I was infected with hepatitis A through a recent blood transfusion. d. My infection with Epstein-Barr virus can co-infect me with hepatitis A.

✅ANS: B The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A. DIF: Applying/Application REF: 1180 KEY: Hepatitis| infection control MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Health Promotion and Maintenance Chapter 58: Care of Patients with Liver Problems iggy

Question 4 of 14 The nurse is teaching a preoperative client who is scheduled for a laparoscopic cholecystectomy ("lap chole"). What statement by the client indicates a need for further teaching? A. "I will likely need oral pain medications for the first few days after my surgery." B. "I should only be hospitalized for 2 to 3 days after my surgery." C. "I will probably not be at risk for complications from this surgery." D. "I should be able to go back to work in the next week or so."

✅ANS: B "I should only be hospitalized for 2 to 3 days after my surgery." A "lap chole" surgery has many advantages over the open traditional surgical method, including a short hospital stay, usually same-day surgery, minimal risk for complications, and the ability to achieve pain control by using oral analgesics.

Question 9 of 14 A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? A. Assist the client to assume a position of comfort. B. Administer opioid analgesic medication. C. Do not administer food or fluids by mouth. D. Measure intake and output every shift.

✅ANS: B Administer opioid analgesic medication. Pain relief is the highest priority for the client with acute pancreatitis. Although measuring intake and output, NPO status, and positioning for comfort are all important, they are not the highest priority.

Question 13 of 14 A client has undergone the Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which nursing actions would the nurse implement to prevent potential complications? (Select all that apply.) Select all that apply. A. Ensure that drainage color is clear. B. Check blood glucose often. C. Place the client in the supine position. D. Check bowel sounds and stools. E. Monitor mental status.

✅ANS: B Check blood glucose often. ✅ANS: D Check bowel sounds and stools. ✅ANS: E Monitor mental status. To prevent potential complications after a Whipple procedure, the nurse would check the client's glucose often to monitor for diabetes mellitus. Bowels sounds and stools would be checked to monitor for bowel obstruction. A change in mental status or level of consciousness could be indicative of hemorrhage. Clear, colorless, bile-tinged drainage or frank blood with increased output may indicate disruption or leakage of a site of anastomosis but is not a precautionary action for the nurse to implement. The client should be placed in semi-Fowler and not supine position to reduce tension on the suture line and the anastomosis site and to optimize lung expansion.

2. A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)

✅ANS: B, E, F Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the clients confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications. DIF: Applying/Application REF: 1187 KEY: Cirrhosis| laboratory results MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential Chapter 58: Care of Patients with Liver Problems iggy

18. A nurse cares for a client who has chronic cirrhosis from substance abuse. The client states, All of my family hates me. How should the nurse respond? a. You should make peace with your family. b. This is not unusual. My family hates me too. c. I will help you identify a support system. d. You must attend Alcoholics Anonymous.

✅ANS: C Clients who have chronic cirrhosis may have alienated relatives over the years because of substance abuse. The nurse should assist the client to identify a friend, neighbor, or person in his or her recovery group for support. The nurse should not minimize the clients concerns by brushing off the clients comment. Attending AA may be appropriate, but this response doesnt address the clients concern. Making peace with the clients family may not be possible. This statement is not client-centered. DIF: Applying/Application REF: 1179 KEY: Cirrhosis| support| coping MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity Chapter 58: Care of Patients with Liver Problems iggy

11. After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the clients understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching? a. I should drink bottled water during my travels. b. I will not eat off anothers plate or share utensils. c. I should eat plenty of fresh fruits and vegetables. d. I will wash my hands frequently and thoroughly.

✅ANS: C The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, and not sharing plates, glasses, or eating utensils are good ways to prevent illness, as is careful handwashing. DIF: Applying/Application REF: 1182 KEY: Hepatitis| infection control MSC: Integrated Process: Nursing Process: Evaluation NOT: Client Needs Category: Health Promotion and Maintenance Chapter 58: Care of Patients with Liver Problems iggy

13. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver? a. A 22-year-old with a history of blunt liver trauma b. A 48-year-old with a history of diabetes mellitus c. A 66-year-old who has a history of cirrhosis d. An 82-year-old who has chronic malnutrition

✅ANS: C The risk of contracting a primary carcinoma of the liver is higher in clients with cirrhosis from any cause. Blunt liver trauma, diabetes mellitus, and chronic malnutrition do not increase a persons risk for developing liver cancer. DIF: Remembering/Knowledge REF: 1181 KEY: Liver cancer| health screening MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care Chapter 58: Care of Patients with Liver Problems iggy

Question 2 of 14 A client is preparing to have a hepatobiliary scan (HIDA scan). What health teaching would the nurse include about what the client can expect during the test? A. "This test measures how inflamed your gallbladder and liver may be." B. "You may eat and drink as much as you'd like before you have this test." C. "You will have to lie still for some time while the camera is very close to your body." D. "I need to know if you are allergic to shellfish because the contrast will be iodine-based."

✅ANS: C "You will have to lie still for some time while the camera is very close to your body." The HIDA scan requires the injection of radioactive medium which is given about 20 minutes before a large camera is positioned very close to the body. The camera moves to assess for biliary flow and to determine if any obstruction is present.

Question 5 of 14 The nurse is teaching a client with gallbladder disease about diet modification. Which meal would the nurse suggest to the client? A. Sausage and scrambled eggs B. Steak and french fries C. Turkey sandwich on wheat bread D. Fried chicken and mashed potatoes

✅ANS: C Turkey sandwich on wheat bread Turkey is an appropriate low-fat selection for this client. High fiber, from the wheat bread, also helps reduce the risk. Typically, diets high in fat, high in calories, low in fiber, and high in refined white carbohydrates place clients at higher risk for developing gallstones. Steak, french fries, fried chicken and mashed potatoes, and sausage are too fatty. Eggs are too high in cholesterol for a client with gallbladder disease.

Question 11 of 14 After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL (13.1 mmol/L). B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain. C. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min. D. Middle-age client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography.

✅ANS: C Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min. The nurse would first assess the young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min. Airway and breathing are the two most important criteria the nurse will use to determine which client to assess first. The dyspneic client is at greatest risk for rapid deterioration and requires immediate assessment and intervention. Acute respiratory distress syndrome is a possible complication of acute pancreatitis. The client with cholecystitis and the client with an elevated temperature will require further assessment and intervention, but these are not medical emergencies requiring the nurse's immediate attention. The older adult client's glucose level will require intervention but, again, is not a medical emergency.

4. A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first? a. Sedate the client to prevent tube dislodgement. b. Maintain balloon pressure at 15 and 20 mm Hg. c. Irrigate the gastric lumen with normal saline. d. Assess the client for airway patency.

✅ANS: D Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this treatment. The client should be sedated, balloon pressure should be maintained between 15 and 20 mm Hg, and the lumen can be irrigated with saline or tap water. However, these are not a higher priority than airway patency. DIF: Applying/Application REF: 1170 KEY: Hemorrhaging| respiratory distress/failure| cirrhosis MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential Chapter 58: Care of Patients with Liver Problems iggy