AH 1 EXAM 4-FALL 22

portal hypertension causes

ascites and esophageal varices

Nasogastric tubes Know risks (aspiration)-

aspiration can be caused by improper tube placement, by laying flat in bed. Excessive coughing or vomiting can dislodge tube

Know the post-operative client education and nursing care for laparoscopic cholecystectomy-

continuous assessment, monitor for GI symptoms. Surgery related complications such as atelectasis. Keep patient NPO or use NG until bowel sounds return. Soft, low fat high carb diet. Pain management, deep breathing, ambulation.

Gastritis-

inflammation of the stomach

An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is:

acetaminophen

How is TPN administered-

central line of PICC line.

When caring for a client with cirrhosis, which symptom(s) should the nurse report immediately?

change in mental status

Dietary education for colostomy-

increased fiber intake.

Which enzyme aids in the digestion of fats?

lipase

Diet recommendations for cholecystitis-

low fat, high protein. Avoid dairy, fried foods and alcohol.

Treatment for ascites-

low sodium diet, diuretics, bed rest, paracentesis, administration of salt-poor albumin

Hepatitis A Manifestations-

mild flu-like symptoms, low-grade fever, anorexia, later jaundice and dark urine, indigestion and epigastric distress, enlargement of liver and spleen

Testicular Cancer Diagnosis:

monthly testicular self-exam (TSE) and annual testicular exam

Colostomy Reportable signs and symptoms-

pale, blue or dark stoma. Skin rash around stoma, with or without blisters.

Hepatitis C Transmission-

blood and bodily fluids. Spread by childbirth, needle stick, long term dialysis, tattoos, unprotected sex.

Food to avoid with GERD-

caffeine, tobacco, beer, milk, peppermint. Do not eat before bedtime.

Diverticular Disease

infection and inflammation of the diverticula in the colon

cholecystitis-

inflammation of gallbladder

Know the correct sequence to an abdominal assessment-

inspection, auscultation, percussion, palpation. RLQ, RUQ, LUQ, LLQ.

A nurse who provides care in a community clinic assesses a wide range of individuals. The nurse should identify which client as having the highest risk for chronic pancreatitis?

A 39-year-old man with chronic alcoholism

A client with calculi in the gallbladder is said to have

cholelithiasis

Nurse assessments for portal hypertension-

daily weights and abdominal girth

Standard precautions-

gloves, hand hygiene

Upper GI bleed Expected findings-

hematemesis (vomiting blood), melena (dark sticky stool)

A client with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis secondary to gallstones. The nurse should anticipate that the client will undergo what intervention?

laparoscopic cholecystectomy

Signs and symptoms of cholecystitis-

pain, tenderness, and rigidity to the RUQ. Pain may radiate to chest or shoulder. N/V

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?

hepatic encephalopathy

Risk factors for acute pancreatitis-

history of gallstones. Alcohol use. Trauma. Metabolic disturbances

Possible electrolyte imbalance with NG tubes-

hypokalemia due to fluid loss from suction.

Lab findings for acute pancreatitis

increased lipase and amylase and bilirubin. Increased WBC, glucose and ESR. Decreased platelets, calcium, and magnesium.

The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent?

lactulose

Signs/symptoms of liver cirrhosis-

liver enlargement, portal obstruction, ascites, infection, peritonitis, GI varices, edema, anemia, vitamin deficiency

What is the recommended dietary treatment for a client with chronic cholecystitis?

low fat diet

Signs and symptoms of chronic pancreatitis-

nausea and vomiting, weight loss, severe epigastric pain radiating to back or left shoulder that is worse when laying flat and relieved when crouched over (pressure to mid-section).

Risk factor/causes and client education for constipation-

chronic laxative use, narcotics, immobility, lack of regular exercise.

Know how to decrease the risks of aspiration for clients with an NG tube-

confirm placement of tube. HOB remains at or above 30. Monitor residual volumes.

What signs would indicate peristalsis is returning-

decreased abdominal distension, return of bowel sounds, flatus, reduced abdominal pain and tenderness.

Measures used to treat and/or reduce the symptoms of GERD-

eat a low fat diet, HOB 30 degrees, use of antacids

Obesity management-

eating healthy, exercise, lifestyle modifications, bariatric surgery

The nurse is assessing a client admited with suspected pancreatitis. Which question will the nurse prioritize when assessing this client?

"How much alcohol do you consume in a day?"

Acute Pancreatitis-

pancreatic duct becomes obstructed and enzymes back up causing auto-digestion and inflammation of the pancreas

Which term describes the passage of a hollow instrument into a cavity to withdraw fluid?

paracentesis

Which is the most common cause of esophageal varices?

portal hypertension

Chronic Pancreatitis-

progressive inflammatory disorder with destruction of the pancreas, where cells are replaced by fibrous tissue causing obstruction of the pancreatic and common bile ducts.

Liver Cirrhosis Treatment and nursing actions/interventions-

promote rest, improve nutritional status- small frequent meals, skin care to reduce itchiness

Laparoscopic cholecystectomy-

remove gallbladder due to gallstones or inflammation

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test?

serum amylase

Client education for gastric bypass surgery-

small frequent meals, no straws. Frequent ambulation. Stop eating if you feel full. Follow dietitians recommendations

Discharge teaching for client going home on TPN-

store in fridge but warm to room temperature before use. No double feedings. How to set up and administer feedings. Use of 10% dextrose if out of formula.

Gastric Bypass surgery-

surgery for obesity. Restricts patients ability to eat

Client teaching/instructions for gastritis-

symptom management. Refrain from eating until symptoms subside. Adequate fluid intake. Pain relief. Promote rest. Avoid alcohol and NSAIDS due to potential for further inflammation.

Which of the following is the most effective strategy to prevent hepatitis B infection?

vaccine

A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis?

weight loss

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply.

• Enlarged liver size • Ascites • Hemorrhoids

Which of the following the are early manifestations of liver cancer? Select all that apply.

• Pain • Continuous aching in the back

The nurse is assessing a 53-year-old woman who has been experiencing dysmenorrhea. What questions should the nurse include in an assessment of the client's menstrual history? Select all that apply.

"Do you ever experience bleeding after intercourse?" "How long is your typical cycle?" "Do you experience cramps or pain during your cycle?"

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching?

"How did this happen? I've been faithful my entire marriage."

A client comes to the clinic reporting urinary symptoms. Which statement would most likely alert the nurse to suspect benign prostatic hyperplasia (BPH)?

"I've had trouble getting started when I urinate, often straining to do so."

A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?

"Maintain a high-carbohydrate, low-fat diet."

A client undergoing treatment for vaginitis is also counseled about measures to prevent its recurrence. Which statement by the client best indicates effective counseling?

"My sexual partner will also need to be treated."

A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response?

"You may have eaten contaminated restaurant food."

The nurse is caring for a client who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? Select all that apply.

- Measure urine output every 8 hours. - Measure abdominal girth daily. - Perform daily weights.

What does the nurse recognize as clinical manifestations consistent with ascites? Select all that apply.

- increased abdominal girth - rapid weight gain - visible distended neck veins - stretch marks

Total Parenteral Nutrition (TPN) What to do if you run out of solution-

10% dextrose and water infused as same rate to prevent hypoglycemia until next TPN solution is available.

Normal BMI

18.5-24.9

Overweight BMI-

25.-29.9

Underweight BMI

< 18.5

A nurse is amending a client's plan of care in light of the fact that the client has recently developed ascites. What should the nurse include in this client's care plan?

Administration of diuretics as prescribed

A nurse is collecting assessment data from a premenopausal client who states that she does not have menses. What term should the nurse use to document the absence of menstrual flow?

Amenorrhea

Complications associated with GERD such as Barrett's esophagus-

Barrett's Esophagus causes altered esophageal mucosa. Can progress to cancer.

Assessment findings for diverticular disease-

CT; diagnostic of choice. colonoscopy can detect pockets and inflammation in the diverticula. Increased WBC.

Hepatic Encephalopathy Early manifestations-

Changes in mental status and motor disturbances

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

Clay-colored stools

The nurse is working with a client who expects to begin menopause in the next few years. What educational topic should the nurse prioritize when caring for a healthy woman approaching menopause?

Client teaching and counseling regarding healthy lifestyles

Which nursing assessment is most important in a client diagnosed with ascites?

Daily measurement of weight and abdominal girth

A group of nurses have attended an in-service on the prevention of occupationally acquired diseases that affect health care providers. What action has the greatest potential to reduce a nurse's risk of acquiring hepatitis C in the workplace?

Disposing of sharps appropriately and not recapping needles

Vaginal infection (Vulvovaginal infections) Risk factors-

Early menarche, perimenopause, menopause, low estrogen levels. Pregnancy, poor hygiene, tight garments, frequent douching, antibiotics, allergies, diabetes, intercourse with an infected partner

liver transplant Management-

Education about long-term measures to promote health-must take anti-rejection medication. Adhere closely to the therapeutic regimen, follow up lab tests and appointments.

Peptic Ulcer Disease Risk factors-

H. Pylori infection. Excessive use of NSAIDS. Alcohol, smoking. Family history

Which is a risk factor for cervical cancer?

Exposure to the human papilloma virus (HPV)

The nurse is teaching a client preventative measures regarding vaginal infections. The nurse should include which factor as an important risk?

Frequent douching

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?

Hepatitis C increases a person's risk for liver cancer.

A nurse is obtaining health history from a woman with suspected cervical cancer. Which of the following would the nurse identify as a possible risk factor?

History of chronic pelvic infections

The nurse is providing education regarding sexually transmitted diseases. Which statement regarding herpes virus 2 (herpes genitalis) is accurate?

In pregnant women with active herpes, babies delivered vaginally may become infected with the virus

The nurse is caring for a client with chronic pancreatitis. Which symptom would indicate the client has developed secondary diabetes?

Increased appetite and thirst

Which statement is true regarding endometriosis?

It affects women of reproductive age

A client with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure?

Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.

Hepatitis C may lead to-

Liver cirrhosis, liver cancer, liver failure, kidney disease

Diet Recommendations chronic pancreatitis-

Low fat diet. Avoid fried fatty foods. No alcohol

Which of the following would a nurse include in a teaching plan for a client with benign prostatic hyperplasia who is not yet a candidate for surgery?

Maintaining optimal bladder emptying

Education for testicular cancer-

Most common cancer in men ages 15 to 35 years.

Herpes Gentitalis (Herpes type 2 infection) Education;

No cure but antiviral agents such as acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir) can suppress symptoms. Recurrences may be associated with stress, sunburn, dental work, inadequate rest, and inadequate nutrition

Portal Hypertension-

Obstructed blood flow through the liver results in increased pressure throughout the portal venous system

esophageal varices

develop from elevated pressure in the veins that drain into the portal system.

Diagnosis of BPH

digital rectal exam used to diagnose, recommended annually for men over age 50.

Nursing interventions for ascites-

Priority assessments: abdominal girth and weight daily Patient may have striae, distended veins, and umbilical hernia, Assess for fluid in the abdominal cavity by percussion for shifting dullness or by fluid wave Monitor for potential fluid and electrolyte imbalances

Signs and symptoms of cholelithiasis-

RUQ pain radiating to shoulder or chest. +murphy's sign. Changes in urine or stool color (stool is lighter in color)

A client with a new diagnosis of gallstones declines surgical intervention and requests information on midigating stratergies. The nurse anticipates teaching to focus on which client behaviors and monitoring strategies?

Recommend a low fiber diet, monitor for fevers and increased abdominal girth.

A nurse is caring for a client with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the client's cognition and behavior. What is the nurse's most appropriate response?

Report this finding to the primary provider due to the possibility of hepatic encephalopathy.

Risk factors for herpes genitalis-

Risk for infants delivered vaginally to become infected; therefore, cesarean delivery may be performed

A nurse is reviewing a journal article about benign prostatic hyperplasia and possible risk factors associated with this condition. Which factor would the nurse most likely find as playing a role in increasing a man's risk for this condition? Select all that apply

Smoking, hypertension, and diabetes

Which of the following would the nurse expect to be done to assess the size of the prostate?

digital rectal examination

A patient has a diagnosis of stage III ovarian cancer and wants to know what organs are involved. What information should be provided to the patient?

The cancer involves metastases outside the pelvis.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?

The client's hepatic function is decreasing.

BPH symptoms and signs

dysuria, hesitancy, the sensation of incomplete bladder emptying

esophageal varices major concern

They are prone to rupture and often are the source of massive hemorrhages from the upper GI tract and the rectum.

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status?

To avoid inflammation of the pancreas

manifestations of testicular cancer-

early manifestation of painless lump or mass in the testes

jaundice

Yellow- or greenish-yellow sclera and skin caused by increased serum bilirubin levels

Know what NG tubes can be used for-

abdominal decompression. SBO/LBO. Postoperatively.

Paralytic Ileus Signs and symptoms-

abdominal distension, constipation, diarrhea, absence of bowel sounds, N/V, pain

The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed?

abdominal paracentesis

Obesity BMI-

above 30

ascites

accumulation of fluid in the peritoneal cavity

The digestion of carbohydrates is aided by

amylase

Know the digestive enzymes the pancreas secretes-

amylase and lipase.

Hepatitis B Nursing interventions/nursing education-

antiviral medication, adequate nutrition, moderate activity and adequate rest. Get vaccinated to reduce risk of getting disease. Goal is to prevent transmission

Treatment for Hepatitis C-

antiviral medications

Transmission of Hepatitis B-

blood and bodily fluids.

The mode of transmission of hepatitis A virus (HAV) includes which of the following?

fecal-oral

Hepatitis A Transmission-

fecal-oral transmission.

Education for Hepatitis C-

fever, vomiting, rash, itching, swelling of abdomen, bruising easily. Dizziness, confusion, dark red, black, or clay colored stools, coffee ground emesis

Constipation Items on a high fiber diet-

flax seeds, fruits veggies, kidney beans, whole wheat bread

When to flush a NG tube and how much to flush with-

flush with 30mL of water before and after medication administration

Cholelithiasis

gallstones

Ways to prevent transmission of Hepatitis B-

get vaccinated, needle precautions, handwashing