CH. 48 - LIVER, PANCREAS

Which topic is most important to include in teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis? a. Taking lactulose b. Avoiding all alcohol use c. Maintaining good nutrition d. Using vitamin B supplements

b. Avoiding all alcohol use

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 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.

A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective? a. Bowel sounds are present. b. Grey Turner sign resolves. c. Electrolyte levels are normal. d. Abdominal pain is decreased.

d. Abdominal pain is decreased. NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status has been effective. Electrolyte levels may be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this to occur to determine whether treatment was effective.

Which focused data should the nurse assess after identifying 4+ pitting edema on a patient who has cirrhosis? a. Hemoglobin b. Temperature c. Activity level d. Albumin level

d. Albumin level The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. The other parameters are not directly associated with the patient's edema.

Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis? a. Lipase b. Calcium c. Bilirubin d. Potassium

a. Lipase Lipase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be useful in evaluating whether the prescribed therapies have been effective.

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. Cigarette smoking 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.

For a patient who has cirrhosis, which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)? a. Assessing the patient for jaundice b. Providing oral hygiene after a meal c. Palpating the abdomen for distention d. Teaching the patient the prescribed diet

b. Providing oral hygiene after a meal Providing oral hygiene is within the scope of UAP. Assessments and assisting patients to choose therapeutic diets are nursing actions that require higher level nursing education and scope of practice and would be delegated to licensed practical/vocational nurses (LPNs/VNs) or RNs.

Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis? a. The patient's urine is bright yellow. b. The patient's stools are tan colored. c. The patient reports chronic heartburn. d. The patient has increased pain after eating.

b. The patient's stools are tan colored. Tan or gray stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a patient with this diagnosis, although the nurse would also report the other assessment information to the health care provider.

A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies, but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is appropriate? a. "Have you taken corticosteroids?" b. "Do you have a history of IV drug use?" c. "Do you use any over-the-counter drugs?" d. "Have you recently traveled to another country?"

c. "Do you use any over-the-counter drugs?" The patient's symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms suggest toxic hepatitis, which can be caused by commonly used over-the-counter drugs such as acetaminophen (Tylenol). Travel to a foreign country and a history of IV drug use are risk factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed.

A 36-yr-old female patient is receiving treatment for chronic hepatitis B with pegylated interferon (Pegasys). Which finding is important to communicate to the health care provider to suggest a change in therapy? a. Nausea and anorexia b. Weight loss of 2 lb (1 kg) c. Positive urine pregnancy test d. Hemoglobin level of 10.4 g/dL

c. Positive urine pregnancy test Because ribavirin is teratogenic, the medication will need to be discontinued immediately. Anemia, weight loss, and nausea are common adverse effects of the prescribed regimen and may require actions such as patient teaching, but they would not require immediate cessation of the therapy.

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. Surface antibody anti-HBs 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.

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. Monitor closely for infection because of the immunosuppressive medication. 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.

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. Primary sclerosing cholangitis 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.

Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)? a. Teach symptoms of variceal bleeding. b. Draw blood for hepatitis serology testing. c. Discuss the need to increase caloric intake. d. Review the patient's current medication list.

d. Review the patient's current medication list. Some medications can increase the risk for NAFLD, and they should be discontinued. NAFLD is not associated with hepatitis, weight loss is usually indicated, and variceal bleeding would not be a concern in a patient with asymptomatic NAFLD.

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. Use of acetaminophen with alcohol use 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.

The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement? a. "I can take a shower and walk around the house tomorrow." b. "I need to limit my activities and not return to work for 4 weeks." c. "I can expect yellowish drainage from the incision for a few days." d. "I will follow a low-fat diet for life because I do not have a gallbladder."

a. "I can take a shower and walk around the house tomorrow." After a laparoscopic cholecystectomy, patients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the patient should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a lifelong requirement.

After an unimmunized person is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take? (Select all that apply.) a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. c. Teach about α-interferon therapy. d. Give hepatitis B immune globulin. e. Explain options for oral antiviral therapy.

a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. d. Give hepatitis B immune globulin. The recommendations for hepatitis B exposure include both vaccination and immune globulin administration. In addition, baseline testing for hepatitis B antibodies will be needed. Interferon and oral antivirals are not used for hepatitis B prophylaxis.

A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider? a. Asterixis and lethargy b. Jaundiced sclera and skin c. Elevated total bilirubin level d. Liver 3 cm below costal margin

a. Asterixis and lethargy The patient's findings of asterixis and lethargy are consistent with grade 2 hepatic encephalopathy. Patients with acute liver failure can deteriorate rapidly from grade 1 or 2 to grade 3 or 4 hepatic encephalopathy and need early transfer to a transplant center. The other findings are typical of patients with hepatic failure and would be reported but would not indicate a need for an immediate change in the therapeutic plan.

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. Avoid nicotine. b. Eat bland foods. c. Observe stools for steatorrhea. 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.

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. Duodenum 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.

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. Fasting c. Parenteral nutrition d. Prolonged immobility 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.

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. It is noninvasive and is a very reliable method of detecting gallstones. 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.

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. Keep the tube supported and free of kinks. 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.

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 with NG suction 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.

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. Obesity b. Age over 40 years c. Multiparous female e. Family history of gallbladder disease f. Use of estrogen or oral contraceptives 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.

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

a. Oral hygiene before meals and snacks 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.

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. Providing adequate nutritional intake 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.

A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate? a. Schedule the patient for HCV genotype testing. b. Administer the HCV vaccine and immune globulin. c. Teach the patient about ribavirin (Rebetol) treatment. d. Explain that the infection will resolve over a few months.

a. Schedule the patient for HCV genotype testing. Genotyping of HCV has an important role in managing treatment and is done before drug therapy is initiated. Because most patients with acute HCV infection convert to the chronic state, the nurse should not teach the patient that the HCV will resolve in a few months. Immune globulin or vaccine is not available for HCV. Ribavirin is used for chronic HCV infection.

Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis? a. The patient is alert and oriented. b. The patient denies nausea or anorexia. c. The patient's bilirubin level decreases. d. The patient has at least one stool daily.

a. The patient is alert and oriented. The purpose of lactulose in the patient with cirrhosis is to lower ammonia levels and prevent encephalopathy. Although lactulose may be used to treat constipation, that is not the purpose for this patient. Lactulose will not decrease nausea and vomiting or lower bilirubin levels.

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. Vitamin B deficiencies c. Vascular congestion of spleen d. Decreased prothrombin production 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.

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. Weight loss b. Diabetes management d. Dietary management of hyperlipidemia 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.

The nurse administering α-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for: a. leukopenia. b. hypokalemia. c. polycythemia. d. hypoglycemia.

a. leukopenia. Therapy with ribavirin and α-interferon may cause leukopenia. The other problems are not associated with this drug therapy.

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. "I must avoid all physical contact with my family until the jaundice is gone." 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.

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. "Those who have had household or close contact with the patient should receive IG." 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.

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. A fresh tomato sandwich with salt-free butter 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.

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 small intestine prevents conversion to urobilinogen and fat emulsion and digestion 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.

What is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices? a. Bilirubin levels b. Ammonia levels c. Potassium levels d. Prothrombin time

b. Ammonia levels The protein in the blood in the gastrointestinal tract will be absorbed and may result in an increase in the ammonia level because the liver cannot metabolize protein very well. The prothrombin time, bilirubin, and potassium levels should also be monitored, but they will not be affected by the bleeding episode.

Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? a. Request that the patient stand on one foot. b. Ask the patient to extend both arms forward. c. Request that the patient walk with eyes closed. d. Ask the patient to perform the Valsalva maneuver.

b. Ask the patient to extend both arms forward. Extending the arms allows the nurse to check for asterixis, a classic sign of hepatic encephalopathy. The other tests might be done as part of the neurologic assessment but would not be diagnostic for hepatic encephalopathy.

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. HBV 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.

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. Increased serum amylase 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.

Which goal has the highest priority in the plan of care for a 26-yr-old patient who was admitted with viral hepatitis, has severe anorexia and fatigue, and is homeless? a. Increase activity level. b. Maintain adequate nutrition. c. Establish a stable environment. d. Identify source of hepatitis exposure.

b. Maintain adequate nutrition. The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration. Finding a home for the patient and identifying the source of the infection would be appropriate activities, but they do not have as high a priority as ensuring adequate nutrition. Although the patient's activity level will be gradually increased, rest is indi cated during the acute phase of hepatitis.

The nurse is planning care for a patient with acute severe pancreatitis. What is the highest priority patient outcome? a. Having fluid and electrolyte balance b. Maintaining normal respiratory function c. Expressing satisfaction with pain control d. Developing no ongoing pancreatic disease

b. Maintaining normal respiratory function Respiratory failure can occur as a complication of acute pancreatitis and maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

What should the nurse teach a patient with chronic pancreatitis is the time to take the prescribed pancrelipase (Viokase)? a. Bedtime b. Mealtime c. When nauseated d. For abdominal pain

b. Mealtime Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal.

What topic should the nurse plan to teach the patient diagnosed with acute hepatitis B? a. Administering α-interferon b. Measures for improving appetite c. Side effects of nucleotide analogs d. Ways to increase activity and exercise

b. Measures for improving appetite Maintaining adequate nutritional intake is important for regeneration of hepatocytes. Interferon and antivirals may be used for chronic hepatitis B, but they are not prescribed for acute hepatitis B infection. Rest is recommended.

A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care? a. Instruct the patient to cough every hour. b. Monitor the patient for shortness of breath. c. Verify the position of the balloon every 4 hours. d. Deflate the gastric balloon if the patient reports nausea.

b. Monitor the patient for shortness of breath. The most common complication of balloon tamponade is aspiration pneumonia. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. Balloons may be deflated briefly every 8 to 12 hours to avoid tissue necrosis, but if only the gastric balloon is deflated, the esophageal balloon may occlude the airway. Balloons are not deflated for nausea.

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. No symptoms except diagnostic results 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.

Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B? a. Advise limiting alcohol intake to 1 drink daily. b. Schedule for liver cancer screening every 6 months. c. Initiate administration of the hepatitis C vaccine series. d. Monitor anti-hepatitis B surface antigen (anti-HBs) levels.

b. Schedule for liver cancer screening every 6 months. Patients with chronic hepatitis are at higher risk for development of liver cancer and should be screened for liver cancer every 6 to 12 months. Patients with chronic hepatitis are advised to completely avoid alcohol. There is no hepatitis C vaccine. Because anti-HBs is present whenever there has been a past hepatitis B infection or vaccination, there is no need to regularly monitor for this antibody.

Which information from a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? a. The patient had a blood transfusion in 2005. b. The patient used IV drugs about 20 years ago. c. The patient frequently eats in fast-food restaurants. d. The patient traveled to a country with poor sanitation.

b. The patient used IV drugs about 20 years ago. Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions given after 1992 (when an antibody test for hepatitis C became available) do not pose a risk for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by contaminated food or by traveling in underdeveloped countries.

The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern? a. The patient reports right upper-quadrant pain with palpation. b. The patient's hands flap back and forth when the arms are extended. c. The patient has ascites and a 2-kg weight gain from the previous day. d. The patient's abdominal skin has multiple spider-shaped blood vessels.

b. The patient's hands flap back and forth when the arms are extended. Asterixis indicates that the patient has hepatic encephalopathy, and hepatic coma may occur. The spider angiomas and right upper quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment. The ascites and weight gain indicate the need for treatment but not as urgently as the changes in neurologic status.

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. Total bilirubin: 3.2 mg/dL (54.7 mmol/L) 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.

The nurse evaluates that administration of hepatitis B vaccine to a healthy patient has been effective when the patient's blood specimen reveals: a. HBsAg. b. anti-HBs. c. anti-HBc IgG. d. anti-HBc IgM.

b. anti-HBs. The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV.

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. hypokalemia. c. renal function. 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.

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. "A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile." 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.

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. "I shouldn't eat any salty foods or foods with high amounts of sodium." 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.

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. "Lamivudine (Epivir) and interferon both decrease viral load and help prevent complications." 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.

During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first? a. A 58-yr-old patient who has compensated cirrhosis and reports anorexia b. A 40-yr-old patient with chronic pancreatitis who has gnawing abdominal pain c. A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C) d. A 36-yr-old patient recovering from a laparoscopic cholecystectomy who has severe shoulder pain

c. A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C) This patient's history and fever suggest possible spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy. The clinical manifestations for the other patients are consistent with their diagnoses and do not indicate complications are occurring.

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 the most important factor in improvement of the patient's condition. 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.

The nurse is caring for a patient with pancreatic cancer. Which nursing action is the highest priority? a. Offer psychologic support for depression. b. Offer high-calorie, high-protein dietary choices. c. Administer prescribed opioids to relieve pain as needed. d. Teach about the need to avoid scratching any pruritic areas.

c. Administer prescribed opioids to relieve pain as needed. Effective pain management will be necessary in order for the patient to improve nutrition, be receptive to teaching, or manage anxiety or depression.

How should the nurse prepare a patient with ascites for paracentesis? a. Place the patient on NPO status. b. Assist the patient to lie flat in bed. c. Ask the patient to empty the bladder. d. Position the patient on the right side.

c. Ask the patient to empty the bladder. The patient should empty the bladder to decrease the risk of bladder perforation during the procedure. The patient would be positioned in Fowler's position and would not be able to lie flat without compromising breathing. Because no sedation is required for paracentesis, the patient does not need to be NPO.

A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical examination? a. Start the hepatitis B immunization series. b. Teach the patient about hepatitis A immune globulin. c. Ask whether the patient has been screened for hepatitis C. d. Test for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM).

c. Ask whether the patient has been screened for hepatitis C. Current CDC guidelines indicate that all patients who were born between 1945 and 1965 should be screened for hepatitis C because many persons who are positive have not been diagnosed. Although routine hepatitis B immunization is recommended for infants, children, and adolescents, vaccination for hepatitis B is recommended only for adults at risk for blood-borne infections. Because the patient has already had hepatitis A, immunization, and anti-HAV IgM levels will not be needed.

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. Assist the patient to the bathroom. 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.

Which action should the nurse in the emergency department take first for a new patient who is vomiting blood? a. Insert a large-gauge IV catheter. b. Draw blood for coagulation studies. c. Check blood pressure and heart rate. d. Place the patient in the supine position.

c. Check blood pressure and heart rate. The nurse's first action should be to determine the patient's hemodynamic status by assessing vital signs. Drawing blood for coagulation studies and inserting an IV catheter are also appropriate. However, the vital signs may indicate the need for more urgent actions. Because aspiration is a concern for this patient, the nurse will need to assess the patient's vital signs and neurologic status before placing the patient in a supine position.

When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next? a. Ask the patient about any arm pain. b. Retake the patient's blood pressure. c. Check the calcium level in the chart. d. Notify the health care provider immediately.

c. Check the calcium level in the chart. The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau's sign. The health care provider should be notified after the nurse checks the patient's calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.

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 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.

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. Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension 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.

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. Is treated with corticosteroids or other immunosuppressive agents 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.

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. It traps ammonia and eliminates it in the feces. 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.

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. Maintain the patient's airway and prevent aspiration of blood. 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.

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. Malabsorption and diabetes mellitus 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.

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis? a. Nausea and vomiting b. Hypotonic bowel sounds c. Muscle twitching and finger numbness d. Upper abdominal tenderness and guarding

c. Muscle twitching and finger numbness

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. Nasogastric (NG) suction to prevent gastric contents from entering the duodenum 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.

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 disease

c. Obstructive jaundice with increased unconjugated and conjugated bilirubin. Gallstones cause obstructive or posticteric jaundice and may increase both conjugated and unconjugated bilirubin.

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. Position the patient on the side with the head of the bed elevated 45 degrees for pain relief. 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.

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. Report any bile-colored or purulent drainage from the incisions. 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.

A patient who has cirrhosis and esophageal varices is being treated with propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective? a. The patient reports no chest pain. b. Blood pressure is 130/80 mm Hg. c. Stools test negative for occult blood. d. The apical pulse rate is 68 beats/min.

c. Stools test negative for occult blood. Because the purpose of β-blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for propranolol is the lack of blood in the stools. Although propranolol is used to treat hypertension, angina, and tachycardia, the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices.

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. Supportive care that is appropriate for all patients with severe liver damage is indicated. 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.

Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago? a. Dry palpebral and oral mucosa b. Crackles at bilateral lung bases c. Temperature 100.8° F (38.2° C) d. No bowel movement for 4 days

c. Temperature 100.8° F (38.2° C) The risk of infection is high in the first few months after liver transplant, and fever is frequently the only sign of infection. The other patient data indicate the need for further assessment or nursing actions and might be communicated to the health care provider, but they do not indicate a need for urgent action.

Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient who was admitted with bleeding esophageal varices? a. The medication will reduce the risk for aspiration. b. The medication will inhibit development of gastric ulcers. c. The medication will prevent irritation of the enlarged veins. d. The medication will decrease nausea and improve the appetite.

c. The medication will prevent irritation of the enlarged veins. Esophageal varices are dilated submucosal veins. The therapeutic action of H2-receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acid gastric contents. Although ranitidine does decrease the risk for peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, these are not the primary purposes for H2-receptor blockade in this patient.

A patient had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to: a. perform leg exercises hourly while awake. b. ambulate the evening of the operative day. c. turn, cough, and deep breathe every 2 hours. d. choose preferred low-fat foods from the menu.

c. turn, cough, and deep breathe every 2 hours. Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing. The other nursing actions are also important to implement but are not as high a priority as ensuring adequate ventilation.

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. "Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?" 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.

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take? a. Withhold both drugs. b. Administer both drugs. c. Administer the furosemide. d. Administer the spironolactone.

d. Administer the spironolactone. Spironolactone is a potassium-sparing diuretic and will help increase the patient's potassium level. The furosemide will further decrease the patient's potassium level and should be held until the nurse talks with the health care provider.

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 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.

A young adult contracts hepatitis from contaminated food. What should the nurse expect serologic testing to reveal during the acute (icteric) phase of the patient's illness? a. Antibody to hepatitis D (anti-HDV) b. Hepatitis B surface antigen (HBsAg) c. Anti-hepatitis A virus immunoglobulin G (anti-HAV IgG) d. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)

d. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM) Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen for hepatitis B or antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity.

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, which causes portal hypertension 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.

What risk factor will the nurse specifically ask about when a patient is being admitted with acute pancreatitis? a. Diabetes b. Alcohol use c. High-protein diet d. Cigarette smoking

d. Cigarette smoking Alcohol use is one of the most common risk factors for pancreatitis in the United States. Cigarette smoking, diabetes, and high-protein diets are not risk factors.

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. Complement system activation by antigen-antibody complexes 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.

Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective? a. Increased serum albumin level b. Decreased indirect bilirubin level c. Improved alertness and orientation d. Fewer episodes of bleeding varices

d. Fewer episodes of bleeding varices TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding from esophageal varices. Indirect bilirubin level and serum albumin levels are not affected by shunting procedures. TIPS will increase the risk for hepatic encephalopathy.

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

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. Have up to 4 small abdominal incisions covered with small dressings 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.

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)

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

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. Impaired computational skills 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.

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. Improved hemodynamic function and renal perfusion 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.

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. Indicates viral replication and effectiveness of therapy for chronic HBV 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.

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

d. It is caused by increased breakdown of RBCs that increases serum unconjugated bilirubin. 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.

Which assessment finding is of most concern for a patient with acute pancreatitis? a. Absent bowel sounds b. Abdominal tenderness c. Left upper quadrant pain d. Palpable abdominal mass

d. Palpable abdominal mass A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

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

d. Pancreatic abscess 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.

A nurse is considering which patient to admit to the same room as a patient who is hospitalized with acute rejection 3 weeks after a liver transplant. Which patient would be the best choice? a. Patient who is receiving chemotherapy for liver cancer b. Patient who is receiving treatment for acute hepatitis C c. Patient who has a wound infection after cholecystectomy d. Patient who requires pain management for chronic pancreatitis

d. Patient who requires pain management for chronic pancreatitis The patient with chronic pancreatitis does not present an infection risk to the immunosuppressed patient who had a liver transplant. The other patients either are at risk for infection or currently have an infection, which will place the immunosuppressed patient at risk for infection.

A patient with chronic hepatitis B infection has several medications prescribed. Which medication order requires clarification with the health care provider before administration? a. Tenofovir (Viread) orally once daily b. Adefovir (Hepsera) orally once daily c. Entecarvir (Baraclude) orally once daily d. Pegylated α-interferon (Pegasys) orally once daily

d. Pegylated α-interferon (Pegasys) orally once daily Pegylated α-interferon is administered subcutaneously, not orally. The medications are all appropriate for a patient with chronic hepatitis B infection.

A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care? a. Restrict daily dietary protein intake. b. Reposition the patient every 4 hours. c. Perform passive range of motion twice daily. d. Place the patient on a pressure-relief mattress.

d. Place the patient on a pressure-relief mattress. The pressure-relieving mattress will decrease the risk for skin breakdown for this patient. Adequate dietary protein intake is necessary in patients with ascites to improve oncotic pressure. Repositioning the patient every 4 hours will not be adequate to maintain skin integrity. Passive range of motion will not take the pressure off areas such as the sacrum that are vulnerable to breakdown.

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. severe left upper quadrant (LUQ) or midepigastric pain. 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.