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Which observation by a nurse would indicate blocked flow of bile from the liver to the intestine? a. Clay-colored stools b. Jaundice c. High blood pressure d. Tachycardia
a. Clay-colored stools Bile is unable to get to feces to give it the normal brown color.
Which drugs and herbal remedies are considered harmful to the liver? (Select all that apply.) a. Comfrey (herbal remedy) b. Promethazine (Phenergan) c. Acetaminophen (Tylenol) d. Oral contraceptive (Yaz) e. Lavender (herbal remedy)
a. Comfrey (herbal remedy) c. Acetaminophen (Tylenol) Herbal remedies of comfrey, borage, coltsfoot, and chaparral can harm the liver. The over-the-counter drug Tylenol is also hepatoxic.
What actions should a nurse implement to correctly assess the progress of ascites on a daily basis? a. Daily weights and abdominal girth measurements b. Intake-output and electrolyte levels c. Blood pressure and pulse d. Daily temperatures and oxygen levels
a. Daily weights and abdominal girth measurements Daily weights and abdominal girth measurements will accurately measure the fluid accumulating in the peritoneal cavity.
The nurse knows that which are the functions of bile? Select all that apply. a. Emulsifies fat b. Removes some toxins c. Neutralizes alkalytic chime d. Helps absorb fat-soluble vitamins e. Converts urobilinogen to bilirubin f. Produced in the gallbladder, aids the liver
a. Emulsifies fat b. Removes some toxins d. Helps absorb fat-soluble vitamins Bile emulsifies fat, breaking it into small particles that can be absorbed. Bile is responsible for removing some toxins. In addition, bile plays a role in the absorption of fat-soluble vitamins. Bile neutralizes acidic rather than alkalytic chime as it leaves the stomach. In the large intestine, bile is converted to urobilinogen and then stercobilin, not bilirubin. Bile is produced in the liver and stored in the gallbladder.REF: p. 848
A nurse is educating a patient diagnosed with hepatitis A. What should the nurse instruct this patient to avoid sharing? a. Food b. Bodies c. Needles d. Housing
a. Food Hepatitis A is spread from contact with saliva, which can be transmitted by shared food or drinks.
A nurse is leading an education class on the various types of hepatitis for newly hired certified nurse assistants (CNAs). Which statement best describes hepatitis A? a. Infectious hepatitis is the most common type and is rarely fatal. b. Serum hepatitis is found in body fluids and is of particular concern to health care workers. c. This type of hepatitis is most likely to result in the person becoming a chronic carrier of the virus. d. Chronic forms of this type do not exist and are considered to be very rare in the United States.
a. Infectious hepatitis is the most common type and is rarely fatal. Hepatitis A is called infectious or epidemic and is transmitted from one person to another through contaminated food, water, or medical equipment. It is the most common type and is rarely fatal. Serum hepatitis is also known as hepatitis B and is found in body fluids and medical equipment that is contaminated. Persons with hepatitis C are more likely to become chronic carriers of the virus. Hepatitis E is similar to hepatitis A; however, it is rarely seen in the United States.REF: p. 856
What is the highest nursing priority outcome when planning the care for the patient with pancreatitis? a. Patient claims satisfaction with pain control. b. Patient states an understanding of medications needed on discharge. c. Patients activity level tolerance shows an increase. d. Patient can maintain a normal bowel pattern.
a. Patient claims satisfaction with pain control. Pain control is the most important priority.
A patient is having blood drawn for suspected liver disease. The PT is 12, and the INR is 1. The laboratory has called the nurse with the results. What is the nurse's best action? a. Place the results in the chart. b. Call the care provider immediately. c. Prepare for assisting with a liver biopsy. d. Institute safety precautions because of an increased risk for bleeding.
a. Place the results in the chart. The PT of 11.0 to 12.6 seconds and the INR of 1 to 1.2 are within normal limits, so no further action is needed unless the care provider has specifically instructed to do so. The patient's results are not indicative of a prolonged clotting time or evidence of liver disease, so a liver biopsy may not be done. The results of the PT and INR do not demonstrate increased risk for bleeding.REF: p. 853
What is necessary to restrict when the ammonia level of a patient diagnosed with cirrhosis continues to rise? a. Protein b. Carbohydrates c. Fats d. Water-soluble vitamins
a. Protein Ammonia is the waste product of protein breakdown. Decreasing protein intake will decrease the end product.
The nurse is providing instructions for a patient who will be having a percutaneous transhepatic cholangiography in 2 days. Which statement by the patient indicates understanding of this procedure? a. "I will be able to leave the facility as soon as the procedure is finished." b. "The nurses will monitor the puncture site and check my blood pressure frequently." c. "This procedure requires that I be on bed rest for a minimum of 12 hours afterward." d. "Results of the test will be discussed with my family while I am recovering from the procedure."
b. "The nurses will monitor the puncture site and check my blood pressure frequently." The percutaneous transhepatic cholangiography is an invasive procedure performed while a needle is inserted into the liver and dye injected. The nurse must closely monitor the puncture site for bleeding and must also monitor vital signs frequently. The patient will be maintained on bed rest for a minimum of 8 hours and will stay at the facility while this is accomplished. The results of the test will be discussed with the patient after the procedure.REF: p. 853
Which factors predispose a patient to disorders of the gallbladder? Select all that apply. a. Male b. 40 years of age c. Obesity d. Fertile e. Sedentary f. Family history
b. 40 years of age c. Obesity d. Fertile e. Sedentary f. Family history The age of 40 years is one of the five factors used to describe persons at risk for gallbladder disorders. Obesity or being overweight is a factor, as is being fertile. A sedentary lifestyle is also a risk factor. Family history can show a tendency toward gallbladder issues. Being female is a greater risk factor than being male.REF: p. 871
The nurse is providing discharge instructions that include education for a patient who was recently diagnosed with hepatitis B. Which information should be included in the teaching plan for this patient? a. The diet should be regular with added vitamin and mineral supplements. b. Activity levels will depend on the patient's signs and symptoms and liver function test results. c. When the patient has completed an antiviral medication, he or she will no longer be contagious. d. It is important to take a medication such as diphenhydramine (Benadryl) around the clock to prevent severe itching.
b. Activity levels will depend on the patient's signs and symptoms and liver function test results. Activity levels depend on the individual patient's signs and symptoms. The diet for a patient who has hepatitis should be high-calorie, high-carbohydrate, moderate- to high-protein, and moderate- to low-fat with supplementary vitamins. Antiviral medications may help to lessen symptoms; however, the patient may still be contagious. Benadryl is helpful for itching when it occurs; however, there is no need to take it routinely.REF: p. 858
A goal of medical treatment for patients with cirrhosis is to prevent complications and limit cell damage. A major approach is to promote rest. What rationale supports this approach? a. Allows time for a transplant b. Allows the liver to regenerate c. Prevents red cell destruction d. Decreases the risk of trauma
b. Allows the liver to regenerate With rest, the liver will regenerate healthy tissue and return to normal functioning. Rest must include other measures to promote healing, such as dietary measures and no alcohol.
What intervention should a nurse implement when assessing a patient with jaundice who has been given the nursing diagnosis of impaired skin integrity? a. Sedate the patient. b. Apply mittens or socks to the hands. c. Restrain the hands. d. Distract the patient with conversation.
b. Apply mittens or socks to the hands. Jaundice causes itching, which can cause the patient to scratching and create a break in the skin. Mittens provide some comfort without causing further skin impairment.
Which instruction should be given to a patient with portal hypertension to reduce the threat of hemorrhage? a. Eat bland foods. b. Avoid straining to have a bowel movement. c. Increase fluid intake. d. Use an electric razor to shave.
b. Avoid straining to have a bowel movement. Straining can increase pressure and may cause the dilated vessels in the gastrointestinal tract to bleed. Shaving with an electric razor does not prevent serious bleeding.
The nurse is caring for a patient who is returning to the unit after a liver biopsy. Which intervention implemented by the nurse is appropriate during the postintervention care of this patient? a. Maintain the patient on the left side for at least 2 hours after the procedure. b. Check vital signs every 15 minutes for the first hour and then according to protocol. c. Encourage the patient to keep the right arm above the head and to take frequent deep breaths. d. Change the pressure dressing every 30 minutes for the first 2 hours and assess the puncture site.
b. Check vital signs every 15 minutes for the first hour and then according to protocol. To monitor for potential complications after a liver biopsy, vital signs are checked every 15 minutes for the first hour and then according to protocol. The patient must remain on the right side for at least 2 hours to maintain pressure on the puncture site. The patient is encouraged to keep the right arm above the head and to take frequent deep breaths during the actual procedure, not postprocedure. The pressure dressing should be checked for bleeding every 15 minutes for the first hour and then every 30 minutes during the second hour; however, the dressing should not be removed or changed.REF: p. 855
What should a nurse include in the discharge teaching for a patient after a laparoscopic procedure for cholelithiasis? a. Take water-soluble vitamins. b. Follow a low-fat diet. c. Expect light-colored stools for several days. d. Keep dressing over the T-tube dry.
b. Follow a low-fat diet. After the laparoscopic procedure, the patient is to follow a low-fat diet and take fat-soluble vitamins. Placement of the T-tube is not done with the laparoscopic procedure.
Which vaccination does the Occupational Health and Safety Administration (OSHA) require all health care providers to receive? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. All strains of hepatitis
b. Hepatitis B OSHA requires that all health care providers be vaccinated against hepatitis B.
A high ammonia level contributes to hepatic encephalopathy. Which nursing implementation needs to be added to the nursing care plan as this level continues to increase? a. Mouth care b. Increased frequency of neurologic checks c. Oxygen saturation monitoring d. Intake and output
b. Increased frequency of neurologic checks As the ammonia level rises, the patient becomes at greater risk for confusion and hepatic coma related to encephalopathy.
Which medication would be given to promote elimination of ammonia in fecal matter and to treat hepatic encephalopathy in a patient with cirrhosis? a. Furosemide (Lasix) b. Lactulose (Cephulac) c. Propranolol (Inderal) d. Spironolactone (Aldactone)
b. Lactulose (Cephulac) Lactulose is used to help eliminate ammonia in feces and to prevent or treat hepatic encephalopathy. Furosemide is used for excretion of excess fluid. Propanolol reduces pressure in veins, decreasing the risk for bleeding. Spironolactone is used to decrease excess fluid.REF: p. 863
What is the meaning of a dropping bilirubin level in a patient diagnosed with hepatitis? a. Red blood cell destruction is decreasing. b. Liver function is improving. c. Kidneys are compensating for liver dysfunction. d. Kupffer cell damage is continuing.
b. Liver function is improving. As liver function improves, the bilirubin level will decrease because of the livers ability to conjugate and excrete the bilirubin. The flow of bile out of the liver increases.
A young woman with severe jaundice has a nursing diagnosis of Altered body image, related to jaundice. The patient says, Will I always be this horrible color? What is the best response by the nurse? a. Yes, but your sclera will return to their previous white color. b. No. The color will fade gradually as liver inflammation decreases. c. Yes, but cosmetics can disguise the color. d. No. The color will change to freckles.
b. No. The color will fade gradually as liver inflammation decreases. Jaundice causes patients to be self-conscious and reclusive because of the change in physical appearance. Patients can be reassured that the color improves as liver function improves, usually in 2 to 4 weeks.
A licensed practical nurse (LPN) is caring for a patient who is being treated with neomycin sulfate. What is the HIGHEST priority instruction that the nurse should give related to this medication? a. Report any changes in gastrointestinal function. b. Report any ringing in the ears or loss of balance. c. Take the medication as ordered by the physician. d. Report frequent episodes of nausea and vomiting.
b. Report any ringing in the ears or loss of balance. The patient should immediately report symptoms of ringing in the ears or loss of balance because these signs are indicative of toxicity. Although taking the medication as ordered and reporting any changes in gastrointestinal function are important, these are not the highest priority instructions. Although the patient may experience nausea, the patient is not likely to experience vomiting associated with this medication. REF: p.863
What precaution should a nurse initiate when caring for a patient with hepatitis B? a. Reverse isolation b. Standard precautions c. Respiratory precautions d. Enteric precautions
b. Standard precautions Standard precautions protect the nurse from organisms that may be in all body fluids.
A nurse reminds a patient with liver disease that the level of _____ in the blood is an indicator of the how well the liver is functioning.
bilirubin The level of indirect bilirubin indicates the effectiveness of the metabolism of proteins by the liver.
What is pruritus related to in the patient diagnosed with hepatitis? a. Decreased fat intake b. Poor appetite and therefore poor protein intake c. Accumulation of bile salts under the skin d. Altered urinary output of bile
c. Accumulation of bile salts under the skin Bile salts accumulate under the skin, causing irritation.
What should a nurse often find in the medical history of a patient diagnosed with pancreatic disease? a. Liver disorders b. Drug abuse c. Alcohol abuse d. Excessive sugar intake
c. Alcohol abuse Pancreatic disease is often related to alcohol abuse.
Which dietary selection should lead the nurse to conclude that the dietary teaching is successful for a patient on a low-sodium diet? a. Bologna sandwich with tomato juice b. Hotdog on a bun with pickle relish and skim milk c. Baked chicken, white rice, and apple juice d. Peanut butter and jelly sandwich with tomato soup
c. Baked chicken, white rice, and apple juice A meal of baked chicken, white rice, and apple juice has the lowest sodium levels.
For which complication should a nurse be careful to monitor a patient after a liver biopsy? a. Headache b. Muscle cramps c. Bleeding d. Respiratory distress
c. Bleeding Liver biopsy places the patient at risk for hemorrhage. Liver disorders make patients especially vulnerable to hemorrhage.
An LPN is caring for a patient who has undergone a liver biopsy. What should be the FIRST action by the nurse after the patient has completed the procedure? a. Maintain the patient on bed rest. b. Maintain the patient on the right side. c. Check the pressure dressing for bleeding. d. Reinforce the pressure dressing as needed.
c. Check the pressure dressing for bleeding. Although all of the nursing actions are important and should be implemented at some point postprocedurally, checking the pressure dressing for bleeding is the first intervention that the nurse should implement after the test. Keeping the patient on his right side maintains the pressure on the puncture site. Bed rest may be maintained even after the patient is allowed to turn off of his right side. The nurse should also reinforce the pressure dressing as needed, but only after the nurse has checked the pressure dressing for bleeding. REF: p. 855
Which chronic condition is related to the presence of chronic pancreatitis? a. Chronic obstructive pulmonary disease (COPD) b. Urinary tract infection (UTI) c. Diabetes mellitus (DM) d. Arteriosclerotic heart disease (ASD)
c. Diabetes mellitus (DM) Patients with chronic pancreatitis are at risk for developing DM because of the destruction of the insulin-secreting cells in the pancreas.
Which risk is significantly increased in patients diagnosed with liver disease? a. Urinary infections b. Systemic infection c. Drug toxicity d. Drug allergy
c. Drug toxicity Because many drugs are metabolized in the liver and a diseased liver does not adequately clear the system of drugs, drug toxicity is an ongoing problem.
A patient was positive for hepatitis B virus, although she had the disease 4 years ago and now is symptom free. What is the nurse aware is true regarding this patient? a. Is likely to have hepatitis B again b. Now has noninfectious hepatitis c. Is an infectious carrier and always will be d. Is at risk for hepatitis E
c. Is an infectious carrier and always will be A certain percentage of persons who have had hepatitis B convert to carriers. They have the live virus, which causes no symptoms in them, but they are able to transmit the disease and always will be infectious.
A nurse is providing information on the medication Pancrease (lipase, protease, amylase) to a patient diagnosed with pancreatitis. Which important instruction should the nurse be sure to include? a. Taken before meals b. Sprinkled on warm food c. Mixed with juice d. Taken 1 hour after eating
c. Mixed with juice Pancreatic enzyme medication takes the place of enzymes missing from the damaged pancreas. The drug should be mixed with juice or applesauce or sprinkled on cold food, but it should not be chewed because it will irritate the mouth and lips.
Which nursing measure takes priority in relation to the care of a patient with a gastroesophageal balloon tube? a. Deflate the balloon periodically. b. Advance the tube as instructed. c. Monitor respiratory status. d. Withhold medications that could decrease restlessness.
c. Monitor respiratory status. Because of the close proximity of the esophagus and trachea, any upward movement of the tube could cause airway obstruction.
The nurse is assigned to observe a patient immediately after a needle biopsy of the liver is performed. Which nursing action would be most appropriate? a. Monitor vital signs every 15 minutes for 1 hour and then hourly. Position the patient on the left side. b. Monitor vital signs every 30 minutes for 2 hours and then hourly. Position the patient in the right side-lying position. c. Monitor vital signs every 15 minutes four times and then every 30 minutes two times. Position the patient on the right side. d. Monitor vital signs every 15 minutes for 1 hour followed by every 30 minutes for the next hour. Position the patient on the left side.
c. Monitor vital signs every 15 minutes four times and then every 30 minutes two times. Position the patient on the right side. Vital signs should be monitored every 15 minutes for the first hour, then every 30 minutes for the next hour, and then hourly. While assessing vital signs, the pressure dressing should be assessed for bleeding. The patient is placed on the right side for at least 2 hours. The patient would be placed on the right side rather than the left side to maintain pressure on the puncture site.REF: p. 855
Which sign indicates that the need for increased fluid intake would be contraindicated in a patient diagnosed with a hepatic disorder? a. Low blood pressure b. Increased urinary output c. Signs of edema d. Bradycardia
c. Signs of edema Edema may indicate fluid overload; therefore, question the intake, as well as electrolyte and cardiac status.
A patient with ascites is scheduled for a LeVeen peritoneal-venous shunt. The patient asks why this needs to be done instead of a paracentesis. What is the best response by the nurse? a. It helps the kidneys retain needed sodium. b. It will decrease the need for analgesics. c. This procedure will prevent the loss of protein. d. The risk of infection is lessened with this procedure.
c. This procedure will prevent the loss of protein. Fluids containing protein are returned to the vascular compartment to retain important elements such as albumin. The retention of albumin reduces fluid accumulation.
What action should a nurse implement to prevent complications in a patient with hepatitis who has been prescribed bedrest? a. Raise the knee gatch to prevent the patient from sliding down in bed. b. Provide undisturbed periods of 6 hours to encourage rest. c. Restrict fluids. d. Encourage turning, coughing, and deep breathing every 2 hours.
d. Encourage turning, coughing, and deep breathing every 2 hours. The nurse must encourage measures that will prevent pneumonia and improve impaired skin integrity because of the increased risk factors associated with bedrest.
An LPN is caring for a patient who has been diagnosed with cholelithiasis. The nurse is contributing to the discharge plan for the patient. What is the HIGHEST priority discharge instruction that the patient should be given? a. Maintain a low-fat diet supplemented with fat-soluble vitamins. b. Keep appointments to have blood drawn for liver function tests. c. Use a second form of birth control other than oral contraceptives. d. Report experiencing light stools, dark urine, jaundice, and itching.
d. Report experiencing light stools, dark urine, jaundice, and itching. Although all of the instructions are important, reporting light stools, dark urine, jaundice and itching is the most important instruction because these symptoms are indicative of bile duct obstruction. The patient should also be instructed to maintain a low-fat diet supplemented with fat-soluble vitamins, keep appointments to have blood drawn for liver function tests, and use a second form of birth control other than oral contraceptives, but these instructions are not the most important. REF: p. 875
A patient in acute pain is admitted with pancreatitis. A nurse reviews a laboratory report showing an elevation that is diagnostic for acute pancreatitis. Which laboratory report did the nurse most likely review? a. Serum bilirubin b. Serum calcium c. Serum lipids d. Serum amylase
d. Serum amylase Serum amylase is the most significant of the diagnostic findings.
An LPN is caring for a patient who is scheduled to undergo magnetic resonance imaging (MRI). What is the MOST important instruction to give the patient? a. She may feel claustrophobic. b. MRI is painless and noninvasive. c. She must lie still on the narrow surface. d. She must remove all metal before the procedure.
d. She must remove all metal before the procedure. Because the risk of significant injury to the patient exists, asking the patient to remove all metal before the procedure is the most important instructional point. After the nurse has impressed upon the patient the importance of removing all metal before the procedure, the nurse should also inform the patient that she may feel claustrophobic, she must lie still on the narrow surface, and that the MRI is painless and noninvasive. REF: p. 854
An LPN is caring for a patient who is scheduled to undergo ultrasonography. What is the HIGHEST priority preprocedural instruction that the nurse should give to this the patient? The patient will: a. be lying on a table during the procedure. b. feel a technician apply gel to the abdomen. c. see images projected onto a screen during the test. d. take nothing by mouth for 8 to 12 hours before the test.
d. take nothing by mouth for 8 to 12 hours before the test. Asking the patient to avoid taking anything by mouth for 8 to 12 hours before the test is the most important preprocedural instruction for the patient. If this status is not maintained, the test cannot take place. After this instruction is given, the nurse can inform the patient that he or she will be lying on a table during the procedure, feel a technician apply gel to the abdomen, and see images projected onto a screen during the test. REF: p. 854
A nurse explains to a patient that when the blood sugar level drops, the liver is capable of converting the stored glycogen to glucose by the process of _____.
glycogenesis The conversion of glycogen to glucose by the liver is called glycogenesis.
A nurse is alert for bleeding in a patient with hepatic disorders because the inflamed liver may not be able to synthesize two clotting factors, which are _____ and _____.
prothrombin; fibrinogen Prothrombin and fibrinogen, which are necessary components for blood clotting, are deficit in liver disorders, leading to bleeding episodes.
In assessing a dark-skinned patient for jaundice, the nurse would assess the _____ for a yellow color.
sclera Jaundice can be assessed by the yellow pigment on the sclera of a dark-skinned person.
