Chapter 45: Care of the Patient with a Gallbladder, Liver, Biliary Tract, or Exocrine Pancreatic Disorder

31. Which factors are most commonly associated with pancreatitis? a. Coronary artery disease b. Alcoholism and biliary tract disease c. Cirrhosis d. History of myocardial infarction

ANS: B Alcoholism and biliary tract disease are the two factors most commonly associated with pancreatitis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1482 OBJ: 2 TOP: Pancreatitis KEY: Nursing Process Step: Assessment

4. What should the nurse expect of a patient with a malabsorption of vitamin K? a. Lowered hemoglobin b. Elevated hematocrit c. Increased prothrombin time d. Diminished white blood cell count

ANS: C Prothrombin times are increased because malabsorption of vitamin K or inability to produce the clotting factors VII, IX, and X cause the patient to have bleeding tendencies. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1465 OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Assessment

15. How does the administration of neomycin (Mycifradin) reduce the production of ammonia? a. By assisting the hepatic cells to regenerate b. By reducing ascites c. By decreasing the bacteria in the gut d. By helping to digest fats and proteins

ANS: C The buildup of ammonia can be prevented with the use of lactulose (Chronulac) and neomycin. Ammonia is produced in the gut by bacterial action. By reducing the bacteria, less ammonia is produced. PTS: 1 DIF: Cognitive Level: Application REF: Pages 1468, 1464, Table 54-1 OBJ: 3 TOP: Encephalopathy KEY: Nursing Process Step: Implementation

50. Arrange the normal process of protein metabolism. (Separate letters by a comma and space as follows: A, B, C, D) a. Protein enters the blood stream b. Excreted by kidney c. Portal vein delivers blood to the liver d. Conversion to urea e. Ammonia produced in the bowel

ANS: A, E, C, D, B Protein products enter the blood stream and are changed in the bowel to ammonia; the products then pass through the portal vein to the liver where the ammonia is converted to urea, which is then excreted by the kidneys. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1465 OBJ: 2 TOP: Protein metabolism KEY: Nursing Process Step: N/A

46. The tumor marker that is elevated in patients with pancreatic cancer is .

ANS: CA19-9 The tumor marker CA19-9 is elevated in the presence of pancreatic cancer. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1484 OBJ: 1 TOP: CA19-9 KEY: Nursing Process Step: N/A

49. The nurse clarifies that deterioration progresses through stages before presenting with liver disease. Place the stages in order. (Separate letters by a comma and space as follows: A, B, C, D) a. Liver disease b. Inflammation c. Hepatic insufficiency d. Destruction e. Fibrotic regeneration

ANS: D, B, E, C, A Liver deterioration follows a pattern of stages: destruction, inflammation, fibrotic regeneration; hepatic insufficiency then presents as liver disease. Topic: Liver destruction Nursing Process Step: Implementation PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1465 OBJ: 2 TOP: Liver destruction KEY: Nursing Process Step: Implementation

44. is a condition characterized by yellowing of the sclera and the skin.

ANS: Jaundice Jaundice is the discoloration of body tissues caused by abnormally high blood levels of bilirubin. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1466 OBJ: 4 TOP: Jaundice KEY: Nursing Process Step: Assessment

47. Hepatitis D is usually seen as a co-infection with _ .

ANS: hepatitis B Hepatitis D is usually seen as a coinfection with hepatitis B. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1473, Box 54-1 OBJ: 6 TOP: Hepatitis KEY: Nursing Process Step: N/A

45. The disease that is on the increase because of the growing obesity population and is associated with coronary artery disease and use of corticosteroids is .

ANS: nonalcoholic fatty liver disease (NAFLD) nonalcoholic fatty liver disease NAFLD NAFLD is a disease that is on the rise due to the increasing population of obese persons. The disease is also associated with CAD and the use of corticosteroids. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1465 OBJ: 2 TOP: NAFLD KEY: Nursing Process Step: N/A

48. A occurs when the body encapsulates the autodigestive debris in the pancreatic tissue, frequently becoming an abscess.

ANS: pseudocyst A pseudocyst occurs when the body encapsulates the autodigestive debris in the pancreatic tissue. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1482 OBJ: 2 TOP: Pseudocyst KEY: Nursing Process Step: N/A

25. The 100 lb patient who has been exposed to hepatitis A is to receive an injection of immune serum globulin. What should the dose (.02 mL/kg) be? a. 0.9 mL b. 1.4 mL c. 1.6 mL d. 1.8 mL

ANS: A 100 lb/2.2 = 45.4. 45.4 0.02 = 0.90 PTS: 1 DIF: Cognitive Level: Application REF: Page 1473 OBJ: 2 TOP: Immune serum globulin KEY: Nursing Process Step: Implementation

9. Which patient statement indicates that the patient requires additional teaching about an endoscopic retrograde cholangiopancreatography? a. "Right after the test, I want breakfast with black coffee." b. "The instrument will be put down my throat." c. "I haven't had anything to eat or drink since 9 PM last night." d. "My doctor said I could have medicine to relax me before the test."

ANS: A After the procedure, keep the patient NPO until the gag reflex returns. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1464 OBJ: 1 TOP: Diagnostic procedures KEY: Nursing Process Step: Planning

24. The nurse is aware that an elevated serum amylase is diagnostic of pancreatitis at an early stage as an elevation can be assessed as early as _ after the onset of pancreatic disease. a. 2 hours b. 8 hours c. 24 hours d. 36 hours

ANS: A An increase in the serum amylase can be detected as early as 2 hours after the onset of pancreatic disease. In simple acute pancreatitis, the level returns to normal in about 36 hours. In chronic disease it remains elevated. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1462 OBJ: 1 TOP: Serum amylase KEY: Nursing Process Step: Assessment

13. The patient's cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of the complication of: a. esophageal varices. b. diverticulosis. c. Crohn disease. d. esophageal reflux (GERD).

ANS: A Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1467 OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Assessment

19. What should the nurse avoid contamination from to prevent the transmission of hepatitis A? a. Food or water b. Blood transfusion c. Needles d. Sexual contact

ANS: A Hepatitis A virus is transmitted when a person puts something in his or her mouth that is contaminated with fecal material (called fecal-oral transmission). Teach patients the importance of good handwashing after the bathroom or changing a diaper, as well as proper food preparation, to prevent the spread of HAV. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1472, Box 54-1 OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step: Planning

20. What is the most appropriate method used by high-risk health workers to prevent hepatitis B? a. Hepatitis B vaccine b. Diligent handwashing c. Wearing protective gear d. Hb immune globulin injections

ANS: A The best preventative measure against the contraction of hepatitis B is HBV vaccine. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1472, Safety OBJ: 5 TOP: Hepatitis B KEY: Nursing Process Step: Planning

29. What is the challenge in encouraging coughing and deep breathing for a postoperative patient who had an open cholecystectomy? a. High placement of incision b. Excessive nausea c. Weakened abdominal muscles d. Poor oxygenation

ANS: A The high placement of the incision of the cholecystectomy makes the patient reluctant to cough. Splinting the incision is beneficial. PTS: 1 DIF: Cognitive Level: Application REF: Page 1480 OBJ: 2 TOP: Cholecystectomy KEY: Nursing Process Step: Implementation

16. What is the most common procedure for the removal of the gallbladder? a. Laparoscopic cholecystectomy b. Cholangiography c. Open cholecystectomy d. Choledochostomy

ANS: A The most recently developed operative procedure, which is now the most common treatment for cholecystitis and cholelithiasis, is done by way of endoscopy. It is called laparoscopic cholecystectomy and uses laser cautery to remove the gallbladder. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1479 OBJ: 8 TOP: Laparoscopic cholecystectomy KEY: Nursing Process Step: Planning

2. The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5 g/dL to 5 g/dL. Based on these findings, what would the nurse expect the patient to exhibit? a. Jaundice b. Edema c. Copious urine output d. Pallor

ANS: B Low serum albumin levels result also from excessive loss of albumin into urine or into third-space volumes, causing ascites or edema. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1459 OBJ: 1 TOP: Cirrhosis KEY: Nursing Process Step: Assessment

26. A family member of a patient asks the nurse about the protein-restricted diet ordered because of advanced liver disease with hepatic encephalopathy. What statement by the nurse would best explain the purpose of the diet? a. "The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system." b. "The liver heals better with a high-carbohydrate diet rather than with a diet high in protein." c. "Most people have too much protein in their diets. The amount in this diet is better for liver healing." d. "Because of portal hypertension, the blood flows around the liver, and ammonia made from protein collects in the brain, causing hallucinations."

ANS: A The patient with hepatic encephalopathy is on a very low-protein to no-protein diet. The goal of management of hepatic encephalopathy is the reduction of ammonia formation in the intestines. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1461 OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Implementation

38. What are the indications for a liver transplant? (Select all that apply.) a. Congenital biliary abnormalities b. Hepatic malignancy c. Chronic hepatitis d. Cirrhosis due to alcoholism e. Gallbladder disease

ANS: A, B, C Indications for liver transplantation include congenital biliary abnormalities, inborn errors of metabolism, hepatic malignancy (confined to the liver), sclerosing cholangitis, and chronic end-stage liver disease. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1474 OBJ: 7 TOP: Liver transplant KEY: Nursing Process Step: Assessment

41. Viral hepatitis may be treated at home. What should be taught to the patient's family? (Select all that apply.) a. Clothes should be laundered separately with hot water. b. Personal items and drinking glasses should not be shared. c. Articles soiled with feces do not require extra care. d. Hands need to be thoroughly washed after toileting. e. Contaminated items may be disposed of with regular trash.

ANS: A, B, D For the patient with viral hepatitis being cared for in the home, the family needs to be taught necessary precautions. Clothes should be laundered separately with hot water. Personal items used by the patient should not be shared. Articles soiled with feces must be disinfected. Any contaminated items should be disposed of properly. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1473 OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step: Implementation

40. Dietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which foods should be avoided? (Select all that apply.) a. Peanut butter b. Grilled chicken c. Rice and pasta d. Bananas, apples, oranges e. Whole milk f. Glazed chocolate doughnuts

ANS: A, E, F Peanut butter, nuts, chocolate, whole milk, fried foods, and cream and other fatty foods should be avoided. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1481 OBJ: 2 TOP: Cholecystitis and cholelithiasis KEY: Nursing Process Step: Assessment

22. A male patient states that he returned from a 2-week camping trip a few days ago. He complains of nausea and anorexia, and dark urine. What additional information would assist in diagnosing hepatitis A? a. Exposure to blood b. Recent ingestion of raw fish c. History of intravenous drug use d. Multiple sex partners

ANS: B Hepatitis A spreads by direct contact through the oral-fecal route, usually by food and water contaminated with feces. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1472, Box 54-1 OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step: Assessment

14. The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient waves to the nurse as she enters the room. How should the nurse interpret this? a. As an attempt to get the nurse's attention b. As asterixis c. As an indication of respiratory obstruction from varices d. As spasticity

ANS: B Asterixis is the "flapping tremor" seen as the patient deteriorates into ammonia intoxication or hepatic encephalopathy. PTS: 1 DIF: Cognitive Level: Application REF: Page 1469 OBJ: 3 TOP: Encephalopathy KEY: Nursing Process Step: Assessment

32. A patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. Which of the following is the best response? a. "Diagnostic tests depend on you not eating anything." b. "The pancreas is stimulated whenever you eat or drink, and causes pain." c. "Eating causes the need for a bowel movement, which excretes your medication too rapidly." d. "Resting your GI tract will cure your pancreatitis."

ANS: B Food and fluids are withheld to avoid stimulating pancreatic activity, and IV fluids are administered. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1482 OBJ: 2 TOP: Pancreatitis KEY: Nursing Process Step: Implementation

23. When caring for an extremely jaundiced patient with cirrhosis, what should the nurse include provisions for in the plan of care? a. Encouraging consumption of a high-fat diet b. Skin care to relieve pruritus c. Offering foods rich in fat-soluble vitamins d. Meticulous foot care

ANS: B Jaundice causes pruritus and can lead to skin lesions and pressure ulcers. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1469 OBJ: 1 TOP: Cirrhosis KEY: Nursing Process Step: Planning

7. Which nursing intervention should be completed immediately after the physician has performed a needle liver biopsy? a. Assisting to ambulate for the bathroom b. Keeping the patient on the right side for a minimum of 2 hours c. Taking vital signs every 4 hours d. Keeping the patient on the left side for a minimum of 4 hours

ANS: B Keep the patient lying on the right side for minimum of 2 hours to splint the puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak. Vital signs are taken every 15 minutes for 30 minutes, then every 30 minutes for 2 hours. PTS: 1 DIF: Cognitive Level: Application REF: Page 1461 OBJ: 2 TOP: Liver biopsy KEY: Nursing Process Step: Implementation

8. Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. What should the nurse suspect? a. Peritonitis b. Pneumothorax c. Hemorrhage of the liver d. Pleural effusion

ANS: B Pneumothorax is a possible complication of paracentesis. The patient's head of the bed should be raised slightly, but kept on the right side. Oxygen should be administered and the assessment reported to the charge nurse and documented. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1461 OBJ: 1 TOP: Pneumothorax KEY: Nursing Process Step: Implementation

6. The nurse caring for a patient who has had an open cholecystectomy with a T-Tube will: a. open the T-tube to the air so that it will drain freely. b. position and secure the drainage bag at the chest level. c. Place the collection bag so the tube is not kinked. d. Irrigate the T-tube with normal saline to ensure the free flow of bile.

ANS: B The T-tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T-tubes are not irrigated. PTS: 1 DIF: Cognitive Level: Application REF: Page 1480 OBJ: 8 TOP: Cholecystectomy KEY: Nursing Process Step: Implementation

35. Which assessment would indicate possible gallbladder disease in an older adult? a. Dull pain in the right upper quadrant region b. Changes in color of urine or stool c. Distention of veins in upper part of body d. Aching muscles and tenderness in the liver

ANS: B The incidence of cholelithiasis increases with aging. Assess older adults for history of changes in stool or urine color. Cirrhosis of the liver may cause distention in veins in the upper part of the body. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1482, Lifespan OBJ: 2 TOP: Age-related changes KEY: Nursing Process Step: Assessment

12. What should the nurse explain is the major purpose of the Sengstaken-Blakemore tube (S/B tube)? a. Decompress the stomach b. Control esophageal varices bleeding c. A route for tube feedings d. Obtain specimen for gastric analysis

ANS: B The major purpose of the S/B tube is to control bleeding by pressure against the vessels in the esophagus. The two balloons of the tube are inflated to put direct pressure on the esophagus and are anchored by the inflated balloon in the stomach. The tube can suction blood from the stomach as well. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1467-1468, Figure 45-4 OBJ: 2 TOP: SB tube KEY: Nursing Process Step: Implementation

1. The nurse clarifies that unconjugated bilirubin, which is made up of broken-down red cells, is: a. stored in the gallbladder to make bile. b. water insoluble bilirubin that must be converted by the liver. c. a by-product which is excreted directly into the bowel for excretion. d. necessary for digestion of fats.

ANS: B Unconjugated bilirubin is a water-insoluble product that must be converted in the liver to conjugated bilirubin (water soluble) so that it may be excreted through the bowel. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1458 OBJ: 1 TOP: Bilirubin KEY: Nursing Process Step: Implementation

37. A patient with a T-tube for an open cholecystectomy has resumed oral intake. The T-tube is clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of fat. During the time the tube is clamped the patient complains of abdominal pain and nausea. Which intervention is most appropriate? a. Notify the physician b. Unclamp the tube immediately c. Increase the IV fluids d. Change the T-tube dressing

ANS: B While the tube is clamped, the patient may show signs of abdominal pain, nausea, vomiting, etc. Unclamp the tube immediately to allow for drainage and relief of both nausea and pain. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1480 OBJ: 8 TOP: Cancer of the pancreas KEY: Nursing Process Step: Implementation

39. Which medical interventions and management systems control the bleeding of esophageal varices? (Select all that apply.) a. Transfusions b. Sengstaken-Blakemore tube c. Band ligation d. Cryotherapy e. Portocaval shunt f. Large doses of vitamin B12

ANS: B, C, E Band ligation, insertion of the S/B tube, and various shunting surgeries are helpful in stopping the hemorrhage. Transfusions and water-soluble vitamins are not beneficial. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1467 OBJ: 3 TOP: Esophageal varices KEY: Nursing Process Step: Assessment

43. What should the nurse do as part of the preparation for an endoscopic retrograde cholangiopancreatography (ERCP)? (Select all that apply.) a. Confirm that a recent chest x-ray is on file b. Confirm the presence of a consent form c. Warn patient that the procedure will take about 3 hours d. Confirm the presence of a prothrombin time/INR e. Withhold food and drink for 4 hours

ANS: B, D Before the ERCP the patient will be held NPO for 8 hours. It is necessary that a consent form be signed as well as evidence of a prothrombin time INR. PTS: 1 DIF: Cognitive Level: Application REF: Page 1463 OBJ: 1 TOP: ERCP KEY: Nursing Process Step: Implementation

42. The nurse is aware that the liver synthesizes products essential to health. Which products are synthesized by the liver? (Select all that apply.) a. Intrinsic factor b. Protein c. Vitamin K d. Red blood cells e. Albumin

ANS: B, E The liver synthesizes protein and albumin. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1459 OBJ: N/A TOP: Products synthesized by liver KEY: Nursing Process Step: Planning

33. Why is morphine contraindicated in the patient with pancreatitis? a. Demerol (meperidine) is less expensive. b. Tylenol is more effective at managing this type of pain. c. Morphine may cause spasms of the sphincter of Oddi. d. These patients do not experience pain.

ANS: C A common complaint is constant, severe pain; in such cases, meperidine (Demerol) PCA is often administered. Morphine may cause spasms of the sphincter of Oddi. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1478 OBJ: 2 TOP: Pancreatitis KEY: Nursing Process Step: Intervention

27. The nurse would make provisions in the plan of care for a person who has had a liver transplant to prevent: a. fluid congestion. b. fatigue. c. infection. d. urinary retention.

ANS: C A critical aspect of nursing care following liver transplantation is monitoring for infection. The major postoperative complications of a liver transplant are rejection and infection. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1474 OBJ: 1 TOP: Liver transplant KEY: Nursing Process Step: Planning

30. Why is it advantageous for a live person to be a liver donor? a. Because the donor is not at risk for any complication b. Because the recipient is more likely to avoid rejection c. Because the donor donates only a part of the liver d. Because the blood supply is more dependable in the donated liver

ANS: C A live donor may donate only a portion of their liver and within weeks the donor's liver has grown to the size to meet the body's needs. The same is true for the recipient. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1474 OBJ: 7 TOP: Liver transplant KEY: Nursing Process Step: Assessment

18. Which of the following is a classic symptom of cholecystitis? a. Substernal, radiating to the left shoulder and arm b. Epigastric, radiating to the back c. Right upper abdomen, radiating to the back or right scapula d. Left upper abdomen, radiating to the jaw and neck

ANS: C It localizes in the right upper quadrant epigastric region. The pain radiates around the mid torso to the right scapular area. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1477-1478 OBJ: 2 TOP: Cholecystitis KEY: Nursing Process Step: Assessment

34. Which factors may increase a patient's risk of developing cancer of the pancreas? a. Diet high in carbohydrates and dairy products b. Cardiovascular disease and glaucoma c. Tea and cola consumption d. Cigarette smokers and people with diabetes mellitus

ANS: D The cause of cancer of the pancreas is unknown, but it is diagnosed more often in cigarette smokers, people exposed to chemical carcinogens, and people with diabetes mellitus and pancreatitis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1484 OBJ: 2 TOP: Cancer of the pancreas KEY: Nursing Process Step: Assessment

36. What should the nurse monitor in caring for the patient undergoing a paracentesis? a. The urinary output b. Hypervolemia c. Fluid removal over at least 30 minutes d. Seizure

ANS: C The fluid removed during a paracentesis is removed over a period of 30 to 90 minutes to prevent sudden changes in blood pressure leading to syncope. The bed should be in a high Fowler position. Food and fluid restriction is usually not necessary. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1467 OBJ: 1 TOP: Paracentesis KEY: Nursing Process Step: Planning

17. What should the nurse do to prepare a patient for an oral cholecystography? a. Ensure that the patient drinks 500 mL of water before testing b. Give 4 Oragrafin (ipodate) 5 minutes apart starting at 6 AM c. Administer 6 Telepaque (iopanoic acid) tablets 5 minutes apart after the evening meal d. Give a fatty meal hour before the test is started

ANS: C The patient is held NPO and given 6 tablets 5 minutes apart the evening before the procedure after the evening meal. A fatty meal is given to the patient after the test is started to stimulate emptying of the gallbladder. PTS: 1 DIF: Cognitive Level: Application REF: Page 1459 OBJ: 1 TOP: Oral cholecystography KEY: Nursing Process Step: Implementation

21. The nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug: a. increases the rate of the regeneration of liver cells. b. can overcome complications presented by hepatitis C. c. increases blood supply to transplant. d. does not suppress bone marrow.

ANS: D Cyclosporine is an immunosuppressant that does not cause bone marrow suppression nor does it impede healing. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1474 OBJ: 7 TOP: Liver transplant KEY: Nursing Process Step: Implementation

5. A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. What is the purpose of the T-tube? a. To decompress the duct and relieve pain caused by stimulation of the sphincter of Oddi. b. To improve diaphragmatic expansion and prevention of atelectasis. c. To shorten postoperative recovery and hasten the healing process. d. To keep the duct open and allow drainage of the bile until edema resolves.

ANS: D If the stones are in the common bile duct and edema is present, a biliary drainage tube, or T-tube, will be inserted to keep the duct open and allow drainage of the bile until the edema resolves. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1479, Figure 45-7 OBJ: 8 TOP: Cholecystectomy KEY: Nursing Process Step: Implementation

28. The nurse is aware that the hepatitis A immunization provides immunity in: a. 5 days. b. 10 days. c. 15 days. d. 30 days.

ANS: D Primary immunization with hepatitis A vaccine provides immunity within 30 days. PTS: 1 DIF: Cognitive Level: Application REF: Page 1473 OBJ: 8 TOP: Hepatitis A KEY: Nursing Process Step: Planning

11. What should the nurse point out as a significant advantage of the laparoscopic cholecystectomy? a. Slightly more invasive, but there is less pain b. Can be performed on all patients of any age c. Can be performed even when there are large stones present in the bile duct d. Less invasive procedure

ANS: D The laparoscopic cholecystectomy is less invasive and causes less pain and a quick recovery. If there are large stones present a sphincterotomy is done before the laparoscopic cholecystectomy. Persons with bleeding tendencies, pathologic conditions of the abdomen, stones in the bile duct, and extensive adhesions are not good candidates. PTS: 1 DIF: Cognitive Level: Application REF: Page 1479 OBJ: 2 TOP: Laparoscopic cholecystectomy KEY: Nursing Process Step: Implementation

3. What is an essential nursing measure to prevent injury to the patient who is to receive a paracentesis? a. Have patient sign a permit b. Pad side rails c. Check for allergy to contrast media or to shellfish d. Have patient void immediately before procedure

ANS: D To prevent the puncturing of the bladder, the patient must void immediately before the procedure. A permit is required but it is not a safety precaution for the patient. There is no contrast media used in a paracentesis. PTS: 1 DIF: Cognitive Level: Application REF: Page 1467 OBJ: 2 TOP: Paracentesis KEY: Nursing Process Step: Implementation

10. The nurse assisting in the treatment of a patient with ruptured esophageal varices who has received vasopressin IV will carefully assess for: a. Muscular twitching/spasm b. Hematuria c. Macular rash on trunk and arms d. Evidence of cardiac ischemia

ANS: D Vasopressin is a strong vasoconstrictor given to try to stop the hemorrhage of the varices. Unfortunately it also constricts all vessels and may cause cardiac ischemia. PTS: 1 DIF: Cognitive Level: Application REF: Page 1467 OBJ: 3 TOP: Vasopressin KEY: Nursing Process Step: Assessment