liver/pancreas prepu
What does the nurse recognize as clinical manifestations consistent with ascites? Select all that apply. a - increase abd girth b - rapid weight gain c - visible distended veins d - stretch marks e - foul-smelling breath
a, b, c, d
The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply. a - alterations in mood b - agitation c - decreased deep tendon reflexes d - report HA e - insomnia
a, b, e
A nurse is teaching a client and the client's family about chronic pancreatitis. Which are the major causes of chronic pancreatitis? a - acute pancreatitis and alcohol consumption b - smoking and alcohol consumption c - malnutrition and caffeine consumption
smoking and alc
A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment? a - prevent vomiting b - to maintain nutritional status c - allows GI tract to rest
GI tract to rest
The nurse is assessing a client admited with suspected pancreatitis. Which question will the nurse prioritize when assessing this client? a - last BM b - how much alcohol do you consume in a day c - how often do you smoke
alcohol
A client comes to the clinic to see the health care provider for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with? a - cholecystitis b - cholelithiasis c - hepatitis d - biliary colic
cholelithiasis: belching, nasuea, RUQ discomfort, pain/cramps after high-fat meal cholecystitis would be sick w fever, vomiting, tenderness over lever, severe pain called biliary colic
Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes? a - inability of liver to synthesize glucagon b - dysfunction of the pancreatic islet cells c - too much sugar in the diet
dysfunction of pancreatic islet cells
A client with alcoholic cirrhosis develops hematemesis. For which intervention will the nurse prepare this client?
endoscopy
A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations?
hepatic encephalopathy earliest s/s: minor mental changes and motor disturbances; slightly confused and unkempt and has alterations in mood and sleep patterns. w/ progression: difficult to awaken and completely disoriented with respect to time and place. further progression: frank coma and may have seizures; simple tasks, such as handwriting, become difficult
A young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issues and assigns the highest priority to which client outcome? a - est a stable home enviornment b - minimize social isolation c - strict bed rest to avoid spread of infection
minimize social isolation
A client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client's plan? a - fluids restriction up t 2 L per day b - increase in potassium c - increase protein d - sodium restriction
sodium restriction
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? a - spirnolactone b - furosemide
spironolactone (aldactone)
A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is most appropriate for a client with this diagnosis? a - withhold all oral intake to decrease pancreatic secretions b - fluid restriction c - supine positioning
withhold oral intake
A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? a - "i will be careful handling food for my family" b - "i will take my meds as ordered" c - "how did this happen? i've been faithful my whole marriage"
"How did this happen? I've been faithful my entire marriage."
The nurse is caring for a client with hepatocellular jaundice. Which finding(s) will the nurse expect to assess in this client? Select all that apply. a - fatigue b - nasuea c - malaise d - weight gain e - constipation
a, b, c
Which of the following the are early manifestations of liver cancer? Select all that apply. a - pain b - continuous backache c - increased appetite d - fever e - jaundice f - fever
a, b early: pain and continuous dull aching in the right upper quadrant epigastrium or back Weight loss, anorexia, and anemia may occur Jaundice is present only if the larger bile ducts are occluded Fever and vomiting are not associated manifestations.
A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply. a - infection at school b - suboptimal sanitary habits c - consumption of sewage-contaminated water or shellfish d - sexual activity e - ingestion of undercooked beef
a, b, c, d
The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply. a - alt nutrition: more than body requirements r/t decreased activity and bed rest b - risk for injury r/t altered clotting mx c - activity intol r/t fatigue, general debility, muscle wasting, discomfort d - urinary incontinence r/t general debility and muscle wasting e - disturbed body image r/t changes in appearance, sexual dysfunction, and role function
b, c, e
The nurse is caring for a client who has just returned from the ERCP removal of gallstones. The nurse should monitor the client for signs of what complications? a - bleeding and perforation b - blood sugar alterations c - gangrene d - peritonitis
bleeding and perforation
A client seeks medical attention for severe abdominal and back pain that is unrelieved with antacids. Which assessment finding indicates to the nurse that the client is experiencing acute pancreatitis? a - diarrhea b - heartburn c - bruising around umbilicus d - R shoulder pain
cullen sign (c) R shoulder = gallbladder disease
What is the most appropriate nursing diagnosis for the client with acute pancreatitis? a - risk for infection b - fluid vol deficit c - fluid vol overload d - risk for injury
fluid vol deficit
A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? a - fried chicken b - dinner roll c - tapioca pudding
fried chicken low-fat liquid diet after acute cholecystitis
A client with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the client's prioritization for receiving a donor liver be determined? a - assess willingness to adhere to post transplant care b - determine client's medical need c - desire of transplant
medical need
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? a - vitamin K b - octreotide c - vasopressin
octreotide tx: IV fluid and blood products as well octreotide reduces pressure in the portal venous system
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis? a - DM b - pancreatic necrosis c - shock d - tetany
pancreatic necrosis
The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of:
serum lipase greater than 3 times the upper limit of normal
A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? a - tacrolimus b - labetalol c - lasix d - gabapentin
tacrolimus
A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this? a - cramps r/t low potassium b - tetany r/t hypocalcemia c - tetany r/t hypercalcemia
tetany r/t hypocalcemia
The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status?
to avoid inflammation of the pancreas
The diagnosis of acute pancreatitis is based on the fulfillment of two out of the three criteria to include
upper abdominal pain serum lipase level greater than 3 times the upper limit of normal serum amylase level greater than 3 times the upper limit of normal increase in the diameter of the pancreas upon computed tomography (CT) scan.
Which of the following terms describes the involuntary flapping movements of the hands associated with metabolic liver dysfunction? a - asterixis b - dialysis c - paracentesis d - ascites
asterixis
A nursing student has learned about many collaborative interventions to achieve pain relief for clients with acute pancreatitis. Which of the following are appropriate? Choose all that apply. a - encourage bed rest to decrease metabolic rate b - teach client about correlation between alcohol intake and pain c - allow sips of clear liquids d - withhold oral feeding to limit release of secretion
a, b, d
When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? a - irritability and drowsiness b - jaundice c - behavioral change d - disorientation
irritability and drowsiness all are associated but irritability and drowsiness suggests decrease in hepatic function s/s disease progression: disorientation, behavioral changes, decreasing LOC, monitor LFTs (ammonia)
The nurse is preparing a teaching tool on pancreatic cancer. Which risk factor(s) will the nurse include in this tool? Select all that apply. a - obesity b - diabetes c - aspirin use d - alc intake e - cigarette smoking
a, b, d, e
A client with a history of pancreatitis seeks medical attention for increasing episodes of abdominal pain. Which assessment finding(s) indicate to the nurse that the client is experiencing chronic pancreatitis? Select all that apply. a - anorexia b - weight loss c - constipation d - rectal bleeding e - foul smelling stools
a, b, e
The nurse is caring for a client who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? Select all that apply. a - measure UO q8hrs b - assess and doc VS q4hr c - measure abd girth daily d - daily weights e - monitor # BMs
a, c, d may also assess resp status, f/e
A client with severe abdominal pain and an abnormal computed tomography (CT) scan, which shows an enlarged pancreas, has been andmitted to a medical unit today. The nurse anticipates including which actions in the client's plan of care? Select all that apply. a - pain scale thru tx b - oral hygiene and gargling solutions c - pain relief measures d - assess nutritional status e - encourage ambulation as tolerated f - maintain NPO diet
a, c, f
A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client? a - treat fever b - relieving abd pain c - daily weights
relieving abd pain
The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. What does the nurse expect was the reason the patient came to the hospital? a - severe abd pain b - black, tarry stool c - extreme cough
severe abd pain
Which is the most common report by clients with pancreatitis? a - black and tarry stool b - severe, radiating abd pain c - painful urination
severe, radiating abd pain
When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor? a - hx pancreatitis b - cushing's syndrome c - hypotension
hx pancreatitis other causes: diabetes mellitus, a high-fat diet, and chronic exposure to carcinogenic substances (i.e., petrochemicals)
A client seeks medical attention for a new onset of mid-back pain that is worse at night when lying supine. Which additional symptom(s) may the nurse use to determine if the client has pancreatic cancer? Select all that apply. a - ascites b - jaundice c - weight loss d - epigastric pain e - lower extremity edema
a, b, c, d,
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? a - the physician will not perform the procedure b - the physician will use an US guided paracentesis c - reschedule
the physician will use an US
A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply. a - glucose metabolism b - ammonia conversion c - protein metabolism d - carb metabolism e - zinc storage
a, b, c
What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention? a - furosemide b - vasopressin c - albumin infusion
albumin infusion corrects the decrease in effective arterial blood vol that lead to Na retention reduces incidence of postparacentesis circulatory dysfunction w renal dysfunction, hyponatremia, rapid reaccumulation of ascites assoc w decreased effective arterial vol
A student nurse is caring for a client who has a diagnosis of acute pancreatitis and who is receiving parenteral nutrition. The student should prioritize which of the following assessments? a - fluid volume b - renal function c - blood glucose
blood sugar
Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels? a - chronic diarrhea b - frequent vomiting, leading to loss of fluid volume c - fluid retention
frequent vom
A client with suspected biliary obstruction due to gallstones reports changes to the color of his stools. Which stool color does the nurse recognize as common to biliary obstruction? a - red b - black c - brown d - gray
gray
Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis? a - semi-fowler positioning b - pain management c - intensive insulin therapy
intensive insulin therapy
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? a - turn pt q4 hrs b - IV fluids c - arrange for a low air loss bed
low air loss bed
A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client? a- semi-fowler's position b - NPO status c - administer morphine IV d - provide mouth care
morphine
A patient who had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. What first-line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices? a - vasopressin b - warfarin c - octreotide
octreotide decreases bleeding without vasoconstrictive effects like vasopressin
Which condition indicates an overdose of lactulose? a - constipation b - watery diarrhea c - congestion
watery diarrhea
