Hepatic/Pancreatic Review

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? Elevated urobilinogen in the urine Straw-colored urine Clay-colored stools Reduced hematocrit

Clay-colored stools

Gynecomastia is a common side effect of which of the following diuretics? Spironolactone (Aldactone) Furosemide (Lasix) Nitroglycerin (IV) Vasopressin (Pitressin)

Spironolactone (Aldactone)

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: Excessive diuresis and dehydration. Severe infections and high fevers. The digestion of dietary and blood proteins. Excess potassium loss subsequent to prolonged use of diuretics.

The digestion of dietary and blood proteins.

inflammation of the gallbladder

cholecystitis

Which is an age-related change of the hepatobiliary system? Decreased prevalence of gallstones Enlarged liver Decreased blood flow Increased drug clearance capability

Decreased blood flow

The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? Spironolactone (Aldactone) Acetazolamide (Diamox) Bumetanide (Bumex) Furosemide (Lasix)

Spironolactone (Aldactone)

A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observed they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis? The physician will not perform the procedure The physician will proceed with the paracentesis at the bedside The physician will use an ultrasound guided paracentesis The physician will have the nurse administer packed RBCs prior to the paracent

The physician will use an ultrasound guided paracentesis

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? Serum potassium level of 3.5 mEq/L Blood pH of 7.25 Loss of 2.2 lb (1 kg) in 24 hours Serum sodium level of 135 mEq/L

Loss of 2.2 lb (1 kg) in 24 hours

procedure used to visualize structures that before could only be seen during laparotomy requires multiple position changes

ERCP

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? Endoscopic retrograde cholangiopancreatography (ERCP) Colonoscopy Cholecystectomy Abdominal x-ray

Endoscopic retrograde cholangiopancreatography (ERCP)

pain in the gallbladder caused by gallstones obstructing bile flow

biliary colic

hormone that controls the release of bile

cholecystokinin

bile duct stones

choledocholithiasis

opening into the common bile duct

choledochostomy

gallstones

cholelithiasis

surgical opening and drainage of gallbladder

cholesystostomy

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: peptic ulcer disease. appendicitis. cirrhosis. cholelithiasis.

cirrhosis.

normal serum bilirubin

0.1-1.2 mg/dL

Vitamins stored in the liver

A, B, D

with pancreatitis, patients should be _________

NPO

major complications of ascities

cardiopulmonary pressure electrolyte imbalance

most severe cirrhosis

decompensated

A client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which is the most appropriate response by the nurse? "Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated." "You can use milk thistle instead of the medications you have been prescribed." "You should not use herbal supplements in conjunction with medical treatment." "Herbal supplements are approved by the FDA, so there should be no problem with their usage if you check with your primary care provider."

"Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated."

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? "You must have the second one in 1 month and the third in 6 months." "You must have the second one in 6 months and the third in 1 year." "You must have the second one in 2 weeks and the third in 1 month." "You must have the second one in 1 year and the third the following year."

"You must have the second one in 1 month and the third in 6 months."

A nurse is responsible for monitoring the diet of a client with hepatic encephalopathy. Which daily protein intake should this 185-pound (84-kilogram) male consume? 16 to 49 grams 100 to 126 grams 50 to 75 grams 76 to 99 grams

100 to 126 grams

vitamins affected by gallstones

A. D. E. K.

A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk? Avoid intake of sodium-rich food. Use aspirin at least once a day. Abstain from drinking alcohol. Increase intake of potassium-rich food.

Abstain from drinking alcohol.

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? Urobilinogen Creatinine Chloride Albumin

Albumin

The single modality of pharmacologic therapy for chronic type B viral hepatitis is: Epivir Baraclude Alpha-interferon Hepsera

Alpha-interferon

The nurse completing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which nursing intervention is appropriate for this problem? Restrict dietary protein intake. Perform passive range-of-motion exercises four times a day. Reposition the client every 4 hours. Arrange for a low air loss bed.

Arrange for a low air loss bed.

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? Constructional apraxia Asterixis Ataxia Fetor hepaticus

Asterixis

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy? Increased motor activity Asterixis Irritability Negative Babinski reflex

Asterixis

A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has? Hepatic insufficiency Bleeding esophageal varices Hemolytic jaundice Portal hypertension

Bleeding esophageal varices

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? Change in the client's handwriting and/or cognitive performance Anorexia for more than 3 days Weight loss of 2 pounds in 3 days Constipation for more than 2 days

Change in the client's handwriting and/or cognitive performance

When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? Yellow-green Clay-colored or whitish Blood tinged Black and tarry

Clay-colored or whitish

Which type of deficiency results in macrocytic anemia? Vitamin K Vitamin A Folic acid Vitamin C

Folic acid

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply. Hemorrhoids Ascites Enlarged liver size Excess storage of vitamin C Accelerated behaviors and mental processes

Hemorrhoids Ascites Enlarged liver size

only occurs with Hep B

Hep D

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

Lactulose

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? Hepatitis A is frequently spread by sexual contact. Infection with hepatitis G is similar to hepatitis A. Hepatitis C increases a person's risk for liver cancer. Hepatitis B is transmitted primarily by the oral-fecal route.

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

When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? Report the condition to the physician immediately. Measure abdominal girth according to a set routine. Ask the client about food intake. Provide the client with nonprescription laxatives.

Measure abdominal girth according to a set routine.

A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding? Epinephrine Octreotide Vasopressin Vitamin K

Octreotide

A client has undergone a liver biopsy. Which postprocedure position is appropriate? Trendelenburg High Fowler On the right side On the left side

On the right side

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease? Apply soft wrist restraints Prevent visitors, so as not to agitate the client Raise all four side rails on the bed Pad the side rails on the bed

Pad the side rails on the bed

The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient? Peripheral vascular assessment related to immobility Respiratory assessment related to increased thoracic pressure Skin assessment related to increase in bile salts Urinary output related to increased sodium retention

Respiratory assessment related to increased thoracic pressure

After undergoing a liver biopsy, a client should be placed in which position? Supine position Right lateral decubitus position Semi-Fowler's position Prone position

Right lateral decubitus position

Octreotide

Sandostatin

The valvecontrolling release of bile and pancreatic juice into the bloodstream.

Sphincter of Oddi

A nurse is educating a client who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the dietary teaching? Increase the amount of magnesium in the diet. Increase the amount of potassium in the diet. The amount of protein is not restricted in the diet. Decrease the amount of fats in the diet.

The amount of protein is not restricted in the diet.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? The client didn't take his morning dose of lactulose (Cephulac). The client's hepatic function is decreasing. The client is avoiding the nurse. The client is relaxed and not in pain.

The client's hepatic function is decreasing.

A female client with chronic hepatitis B has been prescribed recombinant interferon alfa-2b in combination with ribavirin. Which of the following instructions should a nurse provide this client? Maintain an exercise regimen. Avoid calcium-rich foods. Use strict birth control methods. Avoid hot water baths or soaks.

Use strict birth control methods.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? Nitroglycerin Vasopressin Spironolactone Cimetidine

Vasopressin

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? Riboflavin Vitamin A Vitamin K Thiamine

Vitamin A

PT will not improve with _______________ in severe liver damage

Vitamin K

form of cholecystitis that occurs after surgery, trauma, or burns

acalculous cholecystitis

most common cause of chronic pancreatitis

alcohol abuse

cells of the pancreas that secrete glucagon

alpha cells

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: severe abdominal pain radiating to the shoulder. abdominal ascites. eructation and constipation. anorexia, nausea, and vomiting.

anorexia, nausea, and vomiting.

cells of the pancreas that secrete insulin

beta cells

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: can digest high-fat foods. are at risk for gallbladder contraction. cannot tolerate high-glucose concentration. are at risk for hepatic encephalopathy.

cannot tolerate high-glucose concentration.

sclerotherapy

chemical injection into a varicose vein that causes inflammation and formation of fibrous tissue, which closes the vein

an acute inflammation of the bile duct characterized by pain in the upper-right quadrant of the abdomen, fever, and jaundice

cholangitis

less severe cirrhosis

compensated

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? gavage lavage instillation decompression

decompression

This pathway from hepatocytes to bile to intestine and back to the hepatocytes is called the ___________ circulation.

enterohepatic

known to cause increased biliary cholesterol

estrogen, oral contraceptives

before ultrasound of gallbladder, the patient should:

fast overnight to cause distention of the gallbladder

An uncommon, rapidly progressing form that can quickly lead to liver failure, hepatic encephalopathy, or death within 3 weeks

fulminant hep

A hormone secreted by the pancreatic alpha cells that increases blood glucose concentration

glucagon

medications used to decrease duodenal peristalsis

glucagon & anticholinergenics

jaundice occurs in the ________ phase of hepatitis

icteric

hormones secreted by the pancreas

insulin, glucagon, somatostatin

milk thistle & licorice root treat

liver disease

unusual redness of the skin on palms

palmar erythema

best Dx process for pancreatitis

percutaneous fine needle aspiration biopsy

A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer: phytonadione (Mephyton). furosemide (Lasix). spironolactone (Aldactone). warfarin (Coumadin).

phytonadione (Mephyton).

Prothrombin Time (PT) may be _________________ in liver disease

prolonged

meds for pancreatitis

prophylactic antibiotics opoids

major stimulus for release of bicarbonate from the pancreas

secretin

Serum aminotransferases

sensitive indicators of injury to the liver cells, useful in detecting acute liver disease (hepatitis).

opoids can cause _________ of the sphincter of Oddi

spasm

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: elevated blood urea nitrogen and creatinine levels and hyperglycemia. subnormal clotting factors and platelet count. elevated liver enzymes and low serum protein level. subnormal serum glucose and elevated serum ammonia levels.

subnormal serum glucose and elevated serum ammonia levels.

A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider? tachycardia and tachypnea tachycardia and bradypnea bradycardia and tachypnea bradycardia and bradypnea

tachycardia and tachypnea

aids in the digestion of proteins

trypsin

used to dissolve gallstones made of cholesterol

ursodeoxycholic acid chenodeoxycholic acid

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: place the client in a private room. wash her hands after touching the client. wear a gown when providing personal care for the client. wear a mask when handling the client's bedpan.

wash her hands after touching the client.